scholarly journals WT1 as a new prognostic factor and a new marker for the detection of minimal residual disease in acute leukemia

Blood ◽  
1994 ◽  
Vol 84 (9) ◽  
pp. 3071-3079 ◽  
Author(s):  
K Inoue ◽  
H Sugiyama ◽  
H Ogawa ◽  
M Nakagawa ◽  
T Yamagami ◽  
...  
Keyword(s):  
Gene Expression ◽  
Prognostic Factor ◽  
Acute Leukemia ◽  
Dna Markers ◽  
Residual Disease ◽  
Promyelocytic Leukemia ◽  
Myelogenous Leukemia ◽  
Wt1 Gene ◽  
Rt Pcr ◽  
Minimal Residual

The WT1 gene encoding a zinc finger polypeptide is a tumor suppressor gene that plays a key role in the carcinogenesis of Wilms' tumor. Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to examine relative levels of WT1 gene expression (defined in K562 cells as 1.00) in 45 patients with acute myelogenous leukemia (AML), 22 with acute lymphocytic leukemia (ALL), 6 with acute mixed lineage leukemia (AMLL), 23 with chronic myelogenous leukemia (CML), and 24 with non- Hodgkin's lymphoma. Significant levels of WT1 gene were expressed in all leukemia patients and for CML the levels increased as the clinical phase progressed. In striking contrast with acute leukemia, the levels of WT1 gene expression for NHL were significantly lower or even undetectable. Clear correlation was observed between the relative levels of WT1 gene expression (< 0.6 v > or = 0.6) and the prognosis for acute leukemia (AML, ALL, and AMLL). Patients with less than 0.6 levels had significantly higher rates of complete remission (CR), disease-free survival, and overall survival than those with > or = 0.6 levels, whereas CR could not be induced in any of the 7 patients with acute leukemia having greater than 1.0 levels of WT1 gene expression. The quantitation of the WT1 gene expression made it possible to detect minimal residual disease (MRD) in acute leukemia regardless of the presence or absence of tumor-specific DNA markers. Continuous monitoring of the WT1 mRNA was performed for 9 patients with acute leukemia. In 4 patients, MRD was detected 2 to 8 months before clinical relapse became apparent. In 2 other patients, the WT1 mRNA gradually increased after discontinuation of chemotherapy. No MRD was detected in the remaining 3 patients with AML who received intensive induction and consolidation therapy. Simultaneous monitoring of MRD by RT-PCR using primers for specific DNA markers in 3 patients (2 AML-M3 with PML/RAR alpha, and 1 AML-M2 with AML1/ETO) among these 9 patients detected MRD comparable with that obtained from quantitation of WT1 gene expression. In a patient with acute promyelocytic leukemia, the limits of leukemic cell detection by RT-PCR using either WT1 or promyelocytic leukemia/retinoic acid receptor-alpha gene primers were 10(-3) to 10(- 4) and 10(-4) for bone marrow, and 10(-5) and 10(-4) for peripheral blood, respectively. Therefore, we conclude that WT1 is a new prognostic factor and a new marker for the detection of MRD in acute leukemia.

scholarly journals WT1 as a new prognostic factor and a new marker for the detection of minimal residual disease in acute leukemia

Blood ◽  
1994 ◽  
Vol 84 (9) ◽  
pp. 3071-3079 ◽  
Author(s):  
K Inoue ◽  
H Sugiyama ◽  
H Ogawa ◽  
M Nakagawa ◽  
T Yamagami ◽  
...  
Keyword(s):  
Gene Expression ◽  
Prognostic Factor ◽  
Acute Leukemia ◽  
Dna Markers ◽  
Residual Disease ◽  
Promyelocytic Leukemia ◽  
Myelogenous Leukemia ◽  
Wt1 Gene ◽  
Rt Pcr ◽  
Minimal Residual

Abstract The WT1 gene encoding a zinc finger polypeptide is a tumor suppressor gene that plays a key role in the carcinogenesis of Wilms' tumor. Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to examine relative levels of WT1 gene expression (defined in K562 cells as 1.00) in 45 patients with acute myelogenous leukemia (AML), 22 with acute lymphocytic leukemia (ALL), 6 with acute mixed lineage leukemia (AMLL), 23 with chronic myelogenous leukemia (CML), and 24 with non- Hodgkin's lymphoma. Significant levels of WT1 gene were expressed in all leukemia patients and for CML the levels increased as the clinical phase progressed. In striking contrast with acute leukemia, the levels of WT1 gene expression for NHL were significantly lower or even undetectable. Clear correlation was observed between the relative levels of WT1 gene expression (< 0.6 v > or = 0.6) and the prognosis for acute leukemia (AML, ALL, and AMLL). Patients with less than 0.6 levels had significantly higher rates of complete remission (CR), disease-free survival, and overall survival than those with > or = 0.6 levels, whereas CR could not be induced in any of the 7 patients with acute leukemia having greater than 1.0 levels of WT1 gene expression. The quantitation of the WT1 gene expression made it possible to detect minimal residual disease (MRD) in acute leukemia regardless of the presence or absence of tumor-specific DNA markers. Continuous monitoring of the WT1 mRNA was performed for 9 patients with acute leukemia. In 4 patients, MRD was detected 2 to 8 months before clinical relapse became apparent. In 2 other patients, the WT1 mRNA gradually increased after discontinuation of chemotherapy. No MRD was detected in the remaining 3 patients with AML who received intensive induction and consolidation therapy. Simultaneous monitoring of MRD by RT-PCR using primers for specific DNA markers in 3 patients (2 AML-M3 with PML/RAR alpha, and 1 AML-M2 with AML1/ETO) among these 9 patients detected MRD comparable with that obtained from quantitation of WT1 gene expression. In a patient with acute promyelocytic leukemia, the limits of leukemic cell detection by RT-PCR using either WT1 or promyelocytic leukemia/retinoic acid receptor-alpha gene primers were 10(-3) to 10(- 4) and 10(-4) for bone marrow, and 10(-5) and 10(-4) for peripheral blood, respectively. Therefore, we conclude that WT1 is a new prognostic factor and a new marker for the detection of MRD in acute leukemia.

Efficient Duplex Real-Time Quantitative RT-PCR of BCR-ABL and ABL Gene Transcripts for Monitoring of Minimal Residual Disease

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4887-4887
Author(s):  
Qianli Jiang ◽  
Shan Jiang ◽  
Fanyi Meng ◽  
Ru Feng ◽  
Bing Xu ◽  
...  
Keyword(s):  
Real Time ◽  
Minimal Residual Disease ◽  
Residual Disease ◽  
Myelogenous Leukemia ◽  
Rt Pcr ◽  
Exon 2 ◽  
Taqman Probes ◽  
Cancer Group ◽  
Anti Cancer ◽  
Minimal Residual

Abstract BCL-ABL fusion gene can be found in 100% chronic myelogenous leukemia (CML) and about 25% adult acute lympholid leukemia where its expression level is a crucial parameter for monitoring of minimal residual disease (MRD). Depending on the breakpoint in BCR, exon 2 of ABL (a2) joins with exons 1 (e1), 13 (b2), or 14 (b3), or rarely to exon 19 (e19) of BCR resulting in chimeric proteins of p190, p210 and p230, respectively. The c-ABL gene is one of the best controls for MRD detection by real-time quantitative RT-PCR (RQ-RT-PCR). In most studies published before, PCR probes were labeled by single fluorescence such as FAM, and BCR-ABL and ABL transcripts were detected in separate PCR reactions. Purpose: To design and evaluate a duplex, real-time quantitative RT-PCR (RQ-RT-PCR) system labeled with double fluorescence Taqman probes to simultaneously measure both BCR-ABL and ABL transcripts. Methods: Positive controls are plasmids containing full-length target sequence of BCR-ABLP210 and ABL. 70 cases of CML bone marrow samples collected in Nanfang Hospital from Jane 2005 to July 2008 were examined. Patients were untreated ones and those treated with STI571 or allo-hematological stem cell transplantation. RQ-RT-PCR value=copies of BCR-ABL/copies of ABL. The results are compared with fluorescence chromosomal in situ hybridization (FISH) for BCR-ABL. Probes and primers recommended by Europe Anti-Cancer group in 2003 were used as gold standard control; probe and primers for bcr-ablP210 gene are ENF541, ENP501 and ENR561, respectively; probe and primers for abl gene are ENPr1043, ENF1003 and ENR1063, respectively. Both Taqman probes are FAM labed. For duplex RQ-RT-PCR, HEX labeled probe is used for the ABL gene, along with corresponding primers, ENP541 labeled with FAM fluorescence and ENF501 and ENR561 were also used for BCR-ABLP210. The experiments were carried out in the same tube on a Biorad Opticon2 RQ-PCR unit. The end concentration is 0.3μmoL/L for primers and 0. 2 μmoL/L for probe. The PCR reaction was carried out in 25μL. PCR condition is at 50°C×2min+95°C×10min, then followed 95°C×15s+60°C×1min for 50cycle. Result: Testing using serial dilutions of plasmid positive control suggested that HEX-FAM duplex is readily amplified with the FAM Taqman probes of BCR-ABLP210, and the HEX-ABL results is same with those with FAM-ABL (recommeded by Europe Anti-Cancer group). Coefficiency of variation among different experiments is less than 5%. The 70 CML cases can be divide into 3 groups based on FISH value: ≥10% (n=32), 0.5% 10% (n=27) and negative (n=11). The corresponding RQ-PCR ratio of BCR-ABL/ABL are 0.590±0.264, 0.044±0.041 and (9.46±6.99)×10|4, respectively, P&lt;0.01 between each group. Conclusion: We have established an efficient duplex RQ-RT-PCR method with FAM and HEX Taqman probes. This approach enables acquisition of more information from each test and hence reduces the amount of sample needed for each test. We believe this method will be useful to MRD monitoring in CML and BCL-ABL + B-ALL.

Mutation in the Nucleophosmin Gene (NPM1) Is a Stable Marker for Minimal Residual Disease Monitoring in Acute Myeloid Leukemia Patients with Increased Sensitivity and Specificity Compared to Expression of the Wilms Tumor (WT1) Gene.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1602-1602
Author(s):  
Thomas Kristensen ◽  
Birgitte Strange Preiss ◽  
Lone Friis ◽  
Michael B. Møller
Keyword(s):  
Gene Expression ◽  
Myeloid Leukemia ◽  
Residual Disease ◽  
Wilms Tumor ◽  
Normal Karyotype ◽  
Leukemia Cells ◽  
Mutational Load ◽  
Wt1 Gene ◽  
Npm1 Mutation ◽  
Minimal Residual

Abstract Abstract 1602 Poster Board I-628 Mutation in exon 12 of the nucleophosmin (NPM1) gene occurs in approximately 60% of acute myeloid leukemia (AML) patients with normal karyotype. To date, molecular minimal residual disease (MRD) monitoring in this patient group has primarily been based on expression of the Wilms tumor gene (WT1), although expression of WT1 in non-leukemia cells limits the specificity of this marker. Mutation in the NPM1 gene is potentially a superior MRD marker compared to WT1 gene expression by being specific to the malignant clone. The use of NPM1 mutation as a MRD marker would furthermore be in line with the widespread use of leukemia cell specific fusion-genes as MRD markers in AML patients with balanced translocations. In the present study, we therefore evaluated NPM1 mutation as a MRD marker with respect to stability, sensitivity and specificity in direct comparison to WT1 gene expression. A total of 13 relapsed AML patients with normal karyotype that were positive for mutation in NPM1 and WT1 gene expression at the time of diagnosis were included in the study. The NPM1 mutational load and WT1 gene expression was analyzed by real-time qPCR in up to 22 peripheral blood mononuclear cell samples per patient from the time of primary diagnosis to latest follow-up to compare the kinetics of the two markers during periods of morphological remission and relapse events. The 13 patients experienced a total of 18 morphological relapses which were all accompanied by high levels of NPM1 mutation, along with high WT1 mRNA levels, thus demonstrating complete stability of NPM1 mutation during relapse in the present material. During periods of complete morphological remission, the NPM1 mutational load was below detection limit (< 1/1000 cells) in all samples. In contrast, WT1 gene expression was detectable in 70% of these samples, thus demonstrating the limited specificity of this marker. This background WT1 expression in non-leukemia cells reached levels of up to 1% of the levels detected at the time of diagnosis thus limiting the de facto MRD marker sensitivity of WT1. All samples with detectable levels of NPM1 mutation after a period of complete molecular remission were followed by a morphological relapse within weeks. The present study therefore shows that mutation in NPM1 is a stable and more sensitive and specific, and therefore superior, molecular MRD marker than WT1. Disclosures No relevant conflicts of interest to declare.

Significance of Minimal Residual Disease Monitored by Quantitative Assessment of WT1gene in Patients in First Remission of Acute Myeloid Leukemia Before Allogeneic Stem Cell Transplantation

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4485-4485
Author(s):  
Veronika Válková ◽  
Jaroslav Polak ◽  
Marketa Markova ◽  
Hana Hájková ◽  
Antonin Vitek ◽  
...  
Keyword(s):  
Gene Expression ◽  
Myeloid Leukemia ◽  
Residual Disease ◽  
Conditioning Regimen ◽  
Wt1 Gene ◽  
Significant Difference ◽  
Induction Failure ◽  
Minimal Residual ◽  
Acute Myeloid

Abstract Abstract 4485 Purpose Thanks to the development of knowledge in the field of molecular biology, the great progress has been done in risk stratification of patients with acute myeloid leukemia (AML) at diagnosis, in recent years. Based on the recommendations of international expert groups there were identified the patients who may benefit from the allogeneic stem cell transplantation (allo-SCT) as a consolidation of first complete remission (CR). In the absence of an universal marker for minimal residual disease (MRD) measurements, there is still little information about the importance of MRD prior to allo-SCT. Our department has a very good experience with quantitative monitoring of WT1 gene expression as a marker of MRD during treatment of AML. The aim was to retrospectively evaluate the significance of MRD in patients indicated for allo-SCT in 1.CR. Patients and methods Overall 35 patients (pts) in the first morphological CR were transplanted from April 2005 - July 2011. Median age was 46 years (range; 20–63), mens 14, women 21, three good risk, intermediate risk 23, high risk 7 (NA 3). A total of 19 pts achieved CR after second induction (salvage), 11 pts were in 1st iCR. Induction 3+7 was given to 31 pts (4x other), as consolidation has been used HIDAC in 28 pts (7x other). As the graft, peripheral blood stem cells were used in 27 pts, bone marrow in 8 pts. The donor was identical sibling in 15 pts (1x mismatched sibling), matched unrelated donor (MUD) in 10 pts and mismatched UD in 9 pts. Conditioning regimen was myeloablative in 29 pts, reduced-intensity in 6 pts. Median follow-up was 18 months (range; 2–56). The expression of WT1 gene was measured by real-time polymerase chain reaction in peripheral blood according to the European Leukemia Net recommendations. The WT1 expression was related to the expression of a reference gene and the results were calculated with a number of WT1 copies related to 104 copies of ABL gene. The upper limit of normal WT1 expression was set as 50 copies of WT1 to 104 copies of ABL. Before allo-SCT, 25 pts were WT1-negative, ten pts were WT1-positive. Results When comparing the two groups according the MRD status, there was not significant difference in terms of age, risk groups, first induction failure, number of iCR, induction or consolidation type. Also, type of graft, conditioning regimen, or HSCT-CI was not significantly different. The group of WT1-positive pts had more unrelated donors, more aGVHD and shorter follow-up. In terms of cGVHD, the groups were comparable. When comparing the overall survival (OS) and cumulative relapse incidence (RI) of the entire group in terms of: risk group, first induction failure, iCR, consolidations number and incidence of aGVHD, we found no significant difference. Pts with cGVHD had a better OS, lower RI with comparable non-relapse mortality (NRM). In contrast, the MRD status measured by WT1 gene expression appears as clearly significant factor. The outcome of WT1-positive pts is significantly worse in terms of OS (55% vs 83% at 3 years, p = 0.03), RI (50% vs 11% at 3 years, p = 0.008), and there is a trend toward higher NRM (23% vs 5% in 3 years, p = 0.08). Conclusion Our results show that MRD status measured by WT1 gene expression in patients with AML in 1.CR significantly affects their future prognosis. Opportunities to influence the unfavorable prognosis of MRD-positive patients may be more intensive pre-transplantation therapy or earlier immunomodulatory intervention after allo-SCT (pre-emptive DLI). The larger prospective studies are necessary to confirm this hypothesis. The study was supported by scientific project MZ 00023736 granted by the Ministry of Health, Czech Republic. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Feasibility of Implementing Minimal Residual Disease Monitoring in Acute Promyelocytic Leukemia Patients Treated in Developing Countries

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5354-5354
Author(s):  
Ana Paula Alencar de Lima Lange ◽  
Ana Sílvia Gouvea Lima ◽  
Rafael Jacomo ◽  
Raul A Melo ◽  
Rosane Bittencourt ◽  
...  
Keyword(s):  
Acute Promyelocytic Leukemia ◽  
Residual Disease ◽  
Promyelocytic Leukemia ◽  
Rt Pcr ◽  
Molecular Remission ◽  
Chain Reaction ◽  
The Third ◽  
Consolidation Phase ◽  
Polymerase Chain ◽  
Minimal Residual

Abstract Minimal Residual Disease (MRD) monitoring is recognized as a clinically useful tool for the management of Acute Promyelocytic Leukemia (APL) and has been performed by reverse transcriptase Polymerase Chain Reaction (RT-PCR) and Real-Time Quantitative Polymerase Chain Reaction (RQ-PCR). The vast majority of the published studies were conducted in developed countries within well established clinical trials, but the feasibility of MRD monitoring in developing countries is controversial. Here we describe the experience of Brazilian centers that participated in the International Consortium on Acute Promyelocytic Leukemia (IC-APL). In the present study, the participating centers were located at distances up to 2.500 km of central national laboratory and delivery sample time is less than two days. The aim of this study was to determine the feasibility and compare the effectiveness of RQ-PCR and RT-PCR in the MRD research in the context of IC-APL. We analyzed 398 bone marrow (BM) samples from 74 Brazilians patients with de novo APL; mean follow-up of 18 months. Samples were collected at diagnosis (n=74), at post-induction (n=48) after the third consolidation (n=41), and at maintenance (n=235). Standardized assays developed by Europe Against Cancer (EAC) program were used. Clinical characteristics were similar among the full cohort (patients from Brazil [n=122], Mexico [n=30], Chile [n=23], Uruguay [n=8]). Thirty-nine (52%) patients were classified as intermediate risk. PML breakpoint was bcr1 (n=45), bcr2 (n=1), and bcr3 (n=27). The median NCN of transcripts at diagnosis was 0.5151 (n=41) and 0.4690 (n=27) for the bcr1 and bcr3 subtypes, respectively. At the end of induction, there was a reduction of about 3 logs (0.0004 for bcr1 and 0.0005 for bcr3). In this stage, six discrepant cases were observed, all positive by RQ-PCR. There were no relapsed cases. 66/74 (89%) patients completed induction phase and achieved complete remission, and 8/74 (10%) died of hemorrhagic causes. The rate of molecular remission in our study was 37.5% (18/48) by RQ-PCR and 50% (24/48) by RT-PCR. Considering samples obtained at the end of consolidation phase, one discrepant result was detected as negative by RT; however it was not confirmed by RQ-PCR. Both cases did not relapse. The analysis for RQ-PCR was performed in 64% (41/64) of samples. Two patients have died of infectious diseases during the consolidation phase. All patients achieved molecular remission based on the results of RT-PCR. One patient was positive by RQ-PCR (NCN: 0.00006), but all subsequent samples were negative for both techniques, and the patient is alive, in remission. The median NCN of all samples after the third consolidation phase was 0.00001 PML-RARA/104 copies of ABL copies, regardless of the breakpoint. Within 53 patients who have completed the third cycle of consolidation, only 48 started the maintenance. 235 samples were evaluated during maintenance; 87.6% (206/235) were negative by RQ-PCR technique and 94.4% (222/235) by RT-PCR. The median NCN of all samples in the maintenance was 0.00001 PML-RARA/104 copies of ABL copies. The RQ-PCR technique proved to be predictive of relapse in three out of four cases of molecular relapse. All three cases showed positive results for RT-PCR during the early stages of the maintenance cycle and were confirmed by a second sample taken within 15 days. These results are confirmed in literature, observing that most patients who had negative PCR after consolidation relapsed after few months. In one case of molecular relapse, the RQ-PCR analysis provided much earlier warning of recurring disease, testing positive 5 and 6 months, respectively, before documentation of molecular relapse by conventional RT-PCR assay. In two cases, the negative result was performed by RT-PCR post induction, and was not confirmed by RQ-PCR, which remained positive on subsequent samples, and was confirmed once by RT-PCR after long time. According to transcripts numbers at maintenance, there was a decrease of approximately 5 logs when compared to samples after third consolidation. RQ-PCR technique was more sensitive than RT-PCR, providing earlier warning of relapse, thereby allowing greater opportunity for successful delivery of pre-emptive therapy. In sum, the implementation of the IC-APL allowed the improvement of laboratory standards in parallel to advances in clinical management. Disclosures No relevant conflicts of interest to declare.

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