High EVI1 Expression Predicts Adverse Outcomes in Children With De Novo Acute Myeloid Leukemia

• Published in: Frontiers in oncology Vol. 11; p. 712747
• Main Authors: Zheng, Yongzhi, Huang, Yan, Le, Shaohua, Zheng, Hao, Hua, Xueling, Chen, Zaisheng, Feng, Xiaoqin, Li, Chunfu, Zheng, Mincui, Xu, Honggui, He, Yingyi, He, Xiangling, Li, Jian, Hu, Jianda
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 13.09.2021
• Subjects: acute myeloid leukemia; adverse outcome; EVI1; Oncology; pediatric; prognostic factor; transplantation; EVI1; acute myeloid leukemia; prognostic factor; adverse outcome; transplantation; pediatric
• ISSN: 2234-943X; 2234-943X
• DOI: 10.3389/fonc.2021.712747

A high ecotropic viral integration site 1 ( expression ( ) is an independent prognostic factor in adult acute myeloid leukemia (AML). However, little is known of the prognostic value of in pediatric AML. This study aimed to examine the biological and prognostic significance of in uniformly treated pediatric patients with AML from a large cohort of seven centers in China. A diagnostic assay was developed to determine the relative expression using a single real-time quantitative polymerase chain reaction in 421 newly diagnosed pediatric AML patients younger than 14 years from seven centers in southern China. All patients were treated with a uniform protocol, but only 383 patients were evaluated for their treatment response. The survival data were included in the subsequent analysis (n = 35 for , n = 348 for ). was found in 9.0% of all 421 pediatric patients with AML. was predominantly found in acute megakaryoblastic leukemia (FAB M7), rearrangements, and unfavorable cytogenetic aberrance, whereas it was mutually exclusive with t (8; 21), inv (16)/t (16; 16), , , or mutations. In the univariate Cox regression analysis, had a significantly adverse 5-year event-free survival (EFS) and overall survival (OS) [hazard ratio (HR) = 1.821 and 2.401, = 0.036 and 0.005, respectively]. In the multivariate Cox regression analysis, was an independent prognostic factor for the OS (HR = 2.447, = 0.015) but not EFS (HR = 1.556, p = 0.174). Furthermore, was an independent adverse predictor of the OS and EFS of patients with rearrangements (univariate analysis: HR = 9.921 and 7.253, both < 0.001; multivariate analysis: HR = 7.186 and 7.315, = 0.005 and 0.001, respectively). Hematopoietic stem cell transplantation (HSCT) in first complete remission (CR1) provided patients with a tendential survival benefit when compared with chemotherapy as a consolidation (5-year EFS: 68.4% 50.8%, = 0.26; 5-year OS: 65.9% 54.8%, = 0.45). It could be concluded that can be detected in approximately 10% of pediatric AML cases. It is predominantly present in unfavorable cytogenetic subtypes and predicts adverse outcomes. Whether pediatric patients with AML can benefit from HSCT in CR1 needs to be researched further.