The past decade has shown a marked increase in the use of high-throughput assays in clinical research into human cancer, including acute myeloid leukemia (AML). In particular, genome-wide gene expression profiling (GEP) using DNA microarrays has been extensively used for improved understanding of the diagnosis, prognosis, and pathobiology of this heterogeneous disease. This review discusses the progress that has been made, places the technologic limitations in perspective, and highlights promising future avenues. (Blood. 2009;113:291-298)
IntroductionAcute myeloid leukemia (AML) is characterized by a maturation block and accumulation of myeloid progenitor cells. 1,2 Clinically, it has been recognized as a heterogeneous disorder. 1,2 Laboratory support for that notion has come from various directions. Chromosomal abnormalities and gene mutations are common in AML, many of which are apparent in particular subtypes. 3,4 Classification of AML subtypes is clinically relevant, as particular abnormalities are associated with distinct clinical behavior. 1 For instance, recurring reciprocal translocations t(15;17)(q22;q21), t(8;21)(q22;q22), or inv(16)(p13q22)/t(16)16(p13;q22), further abbreviated as t(15;17), t(8;21), and inv(16), respectively, predict favorable prognosis, whereas other chromosomal aberrations are associated with inferior outcome. 1 Likewise, sequence mutations in certain genes are associated with either favorable or unfavorable response to treatment. 4 Insight into cytogenetic and genetic aberrations is invaluable for diagnosis, and it may also allow for better understanding of the pathobiology. Furthermore, it may enable the development and application of specific treatment modalities targeted to underlying oncogenic abnormalities. The efficacy of such drugs as all-trans retinoic acid for the treatment of t(15;17) AML and imatinib for BCR-ABL-positive chronic myeloid leukemia offer well established examples. 5 Despite great progress, much of the heterogeneity of AML remains to be resolved. A significant proportion of human AML appears cytogenetically and genetically normal, which implies that the underlying molecular abnormalities are still unknown. Furthermore, it is likely that in AMLs carrying recognizable aberrations additional hits await to be uncovered, as one lesion usually does not appear sufficient for full leukemic transformation. 6 In recent years, DNA microarrays, together with the availability of the complete nucleotide sequence of the human genome, have spurred the search for abnormalities in cancer, including AML. 7 The accessibility of these tools allows assessment of abnormalities and variations on a genome wide basis, covering various molecular levels. 8 Gene expression profiling (GEP) is one of these technologies, in which DNA microarrays containing cDNAs or oligonucleotide probes are used to simultaneously measure levels of many different mRNA transcripts. [7][8][9][10] In an early landmark study in 1999, Golub and colleagues were able to use GEP to discriminate a collection of AML...