BAALC and ERG expression in acute myeloid leukemia with normal karyotype: impact on prognosis

Abstract

Cytogenetic aberrations are important prognostic factors in acute myeloid leukemia (AML). About 45% of de novo AML lack cytogenetic abnormalities, so identification of predictive molecular markers might improve therapy. We studied the prognostic impact of brain and acute leukemia, cytoplasmic (BAALC) and ETS-related gene (ERG) expression in AML with normal karyotype. Pretreatment bone marrow samples from 30 cytogenetically normal AML patients were analysed for BAALC and ERG expression using real time RT-PCR. The patients were dichotomized at BAALC and ERG mean expression into low and high expression. BAALC showed high expression in 70% of patients and its expression did not correlate with the clinical parameters of patients. ERG was high in 33.3% of patients and its expression was associated with lower ages and higher white cell counts. With follow-up for 2 years, patients with high BAALC and high ERG had low rates of clinical remission (P < 0.005) and inferior overall survival (OS) (P < 0.001 and <0.002 for BAALC and ERG respectively). No significant association was observed between the increase in BAALC and ERG expression (P = 0.398). Multivariable analysis confirmed high BAALC expression as an independent risk factor for OS. Overexpression of BAALC and ERG either separate or concomitant predict adverse clinical outcome and may define important risk factor in cytogenetically normal AML.

The Prognostic Relevance of BAALC and ERG Expression Levels in Cytogenetically Normal Pediatric Acute Myeloid Leukemia

“…This finding is not in accordance with that reported by Eid et al [25], they stated that high expression of BAALC and ERG were found in 70 and 33.3 % of patients respectively. In addition Eid et al [25] stated that the high BAALC and ERG expression was correlated to both percentage of blast cells in the blood and BM, but did not associated with other clinical parameters of patients and high ERG expression was associated with higher white cell counts.…”

“…Also, high BAALC and ERG expression had inferior EFS, and OS. These findings are in parallel with that reported by Eid et al [25]. Univariate analysis revealed that High ERG and BAALC expression; showed a significant association with inferior EFS as well as shorter OS.…”

“…Similar finding was reported by Eid et al [25]. Also, high BAALC and ERG expression had inferior EFS, and OS.…”

“…High ERG and BAALC expression showed a significant association with inferior EFS. These findings are parallel to that reported by Eid et al [25] and Hovland et al [24] Haferlach et al [29]. On the other hand, high BAALC and ERG expression levels did not have independent prognostic significance in pediatric AML cohort or in the CN-AML subgroup specifically in the study done by Hermkens et al [30].…”

ETS-related gene is a novel prognostic factor in childhood acute lymphoblastic leukemia

“…ERG gene rearrangements have been identified in Ewing sarcoma and prostate cancer (8,9). Previous studies suggest that ERG overexpression is associated with inferior clinical outcome (10,11) and is an independent prognostic factor in cytogenetically normal acute myeloid leukemia (AML) (12)(13)(14). Furthermore, in acute T cell-lymphoblastic leukemia (T-ALL) patients, a high level of ERG expression has been associated with poor relapse-free survival (RFS) (15,16).…”