Prognostic Significance Of EVI1 Expression In Adult Acute Myeloid Leukemia Patients

Objective: To investigate the EVI1 gene and other fusion gene expression rate and clinical characteristics in adult acute myeloid leukemia(AML),meanwhile the clinical characteristics, efficacy and prognosis were observed in primary acute myeloid leukemia patients with the fusion gene expression.Method: The retrospective methodology includes in this study. 144 patients in total with primary acute myeloid leukemia(no-M3) were enrolled at Fujian Medical University Union Hospital between 2011 March,01 to 2013 December, 31. All AML were diagnosed by Morphology, Immunology, Cytogenetics and Molecular Biology include the transformed from MDS. Clinical characteristics, treatment response, overall survival(OS) and Event-free survival(EFS) had been had been comparatively and statistically analyzed.Result: Among the 144 AML patients, 23 cases with EVI1 expression, 16 cases with AML1/ETO expression, 12 cases with HOX11 expression, 11 cases with CBFβ/MYH11 expression, 15 cases with MLL fusion gene expression, 2 cases with SET/CAN expression, 1 case with Tel/ABL expression, 1 case with TLS/ERG expression. Compare with the EVI1-, there is no Statistical significance in Clinical characteristics such the WBC count, PLT, age and gender. 50 percents of the EVI1+ AML reached complete remission(CR), statistically no significant elevation compared with 70 pecent of the EVI1-AML reached CR(p=0.092), the median survival time of patients with EVI1+ was 8.17(6.9-15.8)months and was no significantly lower than patients with EVI1- 14.83(10.57-19.10)months, but By Kaplan-Meier survival analysis, EVI1+ predicted the poor event free survival(EFS)(p=0.017), In the intermediate-risk acute myeloid leukemia which risked by the chromosome karyotype EVI1+ predicted the poor overall survival(OS) and EFS(OS,p<0.01;EFS,p<0.01), In CN-AML, EVI1+ also show the adverse prognostic indicator in the EFS and OS(OS,p<0.01;EFS,p<0.01). 17 cases with MLL gene rearrangements were found in 144 AML patience, include 6 cases with MLL/AF6, 3 cases with MLL/ENL, 4 cases with MLL/AF9, 2 cases with MLL/AF10, 2cases with dup MLL. There is no Statistical significance in Clinical characteristics such the WBC count, hemoglobin, PLT, age, gender and FAB classification compare with the patience without MLL gene rearrangements. The expression of the MLL gene rearrangements was significantly associated with shortened CR, OS and EFS in the total patient population as well as in the subgroups of patients with intermediate risk cytogenetic. HOX11, AML1/ETO, CBFβ/MYH11 expression has not a prognostic impact on the outcome.Conclusion: 1. EVI1 expression is a frequent molecular biology abnormal in the adult acute myeloid leukemia. It predicts poor outcome, particularly among intermediate cytogenetic risk AML and CN-AML. Pretreatment EVI1 screening should be included in risk stratification; 2. MLL gene rearrangements also is a frequent molecular biology abnormal in the adult acute myeloid leukemia. Also the patience with the MLL gene rearrangements have a prognostic impact on the outcome.