High receptor tyrosine kinase (FLT3, KIT) transcript versus anti-apoptotic (BCL2) transcript ratio independently predicts inferior outcome in pediatric acute myeloid leukemia

Role of CD135/CD117 on Prognosis and Overall Survival of Acute Myeloid Leukemia

Background:

The key proliferative RTKs for AML include c-KIT receptor (CD117) and FLT-3 receptor (CD135). The aim of this study was to evaluate the CD135 and CD117 expression, co-expression of CD135 and CD117 (CD135+CD117), and the association of that co-expression with Event Free Survival (DFS) and Overall Survival (OS) rates.

Material and Methods:

We analyzed CD117 and CD135 expression on AML blasts by flow cytometry and its association with Event Free Survival (DFS) and Overall Survival (OS) in 66 AML treated on Hematology-Oncology Research Center, Iran, Tabriz.

Results:

The overall OS and EFS were 50% and 80.3% respectively during our study. Cox-regression analysis revealed that a poor EFS was significantly associated a low CD135 (HR 0.34, 95% CI 0.13–0.88, P = 0.02).

Conclusion:

This is the first study from Iran to show that the expressions of CD135, CD117 is easily measurable by routine diagnostic flow-cytometry, and CD135+117 were not significantly associated with CR, EFS, or OS .

BCL2 overexpression: clinical implication and biological insights in acute myeloid leukemia

Background

BCL2 protein inhibitor venetoclax (ABT-199) has been authorized by Food and Drug Administration for relapsed/refractory chronic lymphoid leukemia with 17p deletion. Although venetoclax/ABT-199 also caused cell death in acute myeloid leukemia (AML), whether it could be applied to clinical treatment needs further studies. Here, we revealed clinical implication of BCL2 overexpression in de novo adult AML, and may provide theoretical basis for targeted therapy using venetoclax.

Methods

BCL2 expression was analyzed in adult AML patients from public datasets The Cancer Genome Atlas (TCGA) and confirmed by another independent cohort from our own data.

Results

BCL2 expression showed up-regulated in AML patients among TCGA data and confirmed by our own data. BCL2 overexpression was correlated with FAB-M0/M1, whereas BCL2 under-expression was related to FAB-M5. However, BCL2 expression has no effect on overall survival (OS) and leukemia-free survival (LFS) of AML patients (determined in BCL2^low and BCL2^high groups). Interestingly, in the BCL2^low group, patients undergoing autologous or allogeneic hematopoietic stem cell transplantation (auto/allo-HSCT) had significantly better OS and LFS compared with patients only received chemotherapy, whereas, no significant difference was found in OS and LFS between chemotherapy and auto/allo-HSCT patients in the BCL2^high group. BCL2 expression was found positively correlated with HOX family gene, and negatively correlated with tumor suppressor microRNA such as miR-195, miR-497, and miR-193b.

Conclusions

BCL2 overexpression identified specific FAB subtypes of AML, but it did not affect prognosis. Patients with BCL2 overexpression did not benefit from auto/allo-HSCT among whole-cohort-AML and cytogenetically normal AML.

Electronic supplementary material

The online version of this article (10.1186/s13000-019-0841-1) contains supplementary material, which is available to authorized users.