Based on molecular aberrations, in particular the NPM1 mutation (NPM1(mut)) and 
the FLT3 internal tandem duplication (Flt3-ITD), prognostic subgroups have been 
defined among patients with acute myeloid leukemia with normal karyotype. 
Whereas these subgroups are known to play an important role in outcome in first 
complete remission, and also in the indication for allogeneic stem cell 
transplantation, data are limited on their role after transplantation in 
advanced disease. To evaluate the role of molecular subgroups of acute myeloid 
leukemia with normal karyotype after allogeneic stem cell transplantation beyond 
first complete remission, we analyzed the data from 141 consecutive adults 
(median age: 51.0 years, range 18.4-69.3 years) who had received an allogeneic 
transplant either in primary induction failure or beyond first complete 
remission. A sequential regimen of cytoreductive chemotherapy (fludarabine, 
high-dose AraC, amsacrine) followed by reduced intensity conditioning 
(FLAMSA-RIC), was uniformly used for conditioning. After a median follow up of 
three years, overall survival from transplantation was 64 ± 4%, 53 ± 4% and 44 ± 
5% at one, two and four years, respectively. Forty patients transplanted in 
primary induction failure achieved an encouraging 2-year survival of 69%. Among 
101 patients transplanted beyond first complete remission, 2-year survival was 
81% among patients with the NPM1(mut)/FLT3(wt) genotype in contrast to 43% in 
other genotypes. Higher numbers of transfused CD34(+) cells (hazard ratio 2.155, 
95% confidence interval 0.263-0.964, P=0.039) and favorable genotype (hazard 
ratio 0.142, 95% confidence interval: 0.19-0.898, P=0.048) were associated with 
superior overall survival in multivariate analysis. In conclusion, patients with 
acute myeloid leukemia with normal karyotype can frequently be rescued after 
primary induction failure by allogeneic transplantation following FLAMSA-RIC. 
The prognostic role of NPM1(mut)/FLT3-ITD based subgroups was carried through 
after allogeneic stem cell transplantation beyond first complete remission.