Risk Group Definition in Children with Acute Myeloid Leukemia by Calculating Individual Risk Factors on the Basis of a Multivariate Stepwise Cox Regression Analysis

Acute myeloid leukemia (AML) is one of the most common hematopoietic malignancies that has an unfavorable outcome and a high rate of relapse. Autophagy plays a vital role in the development of and therapeutic responses to leukemia. This study identifies a potential autophagy-related signature to monitor the prognoses of patients of AML. Transcriptomic profiles of AML patients (GSE37642) with the relevant clinical information were downloaded from Gene Expression Omnibus (GEO) as the training set while TCGA-AML and GSE12417 were used as validation cohorts. Univariate regression analyses and multivariate stepwise Cox regression analysis were respectively applied to identify the autophagy-related signature. The univariate Cox regression analysis identified 32 autophagy-related genes (ARGs) that were significantly associated with the overall survival (OS) of the patients, and were mainly rich in signaling pathways for autophagy, p53, AMPK, and TNF. A prognostic signature that comprised eight ARGs (BAG3, CALCOCO2, CAMKK2, CANX, DAPK1, P4HB, TSC2, and ULK1) and had good predictive capacity was established by LASSO–Cox stepwise regression analysis. High-risk patients were found to have significantly shorter OS than patients in low-risk group. The signature can be used as an independent prognostic predictor after adjusting for clinicopathological parameters, and was validated on two external AML sets. Differentially expressed genes analyzed in two groups were involved in inflammatory and immune signaling pathways. An analysis of tumor-infiltrating immune cells confirmed that high-risk patients had a strong immunosuppressive microenvironment. Potential druggable OS-related ARGs were then investigated through protein–drug interactions. This study provides a systematic analysis of ARGs and develops an OS-related prognostic predictor for AML patients. Further work is needed to verify its clinical utility and identify the underlying molecular mechanisms in AML.

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ITGB2 Expression is Negatively Correlated with the Prognosis of Acute Myeloid Leukemia

10.21203/rs.3.rs-593369/v1 ◽

2021 ◽

Author(s):

Jianan Zhou ◽

Bobin Chen ◽

Pei Li

Keyword(s):

T Cells ◽

Acute Myeloid Leukemia ◽

Regression Analysis ◽

Mast Cells ◽

Myeloid Leukemia ◽

Cox Regression ◽

Gene Set Enrichment Analysis ◽

Ppi Network ◽

Cox Regression Analysis ◽

Acute Myeloid

Abstract Objective: Acute myeloid leukemia (AML) is a clonal malignant hematological neoplasm with a poor prognosis and high heterogeneity. Many studies have been conducted on the diagnosis and treatment of AML, but the immune microenvironmental mechanisms underlying AML disease progression have not been fully elucidated. The aim of this study was to find the potential genes in tumor microenvironmental mechanisms underlying the initiation and progression of AML through relevant biological informatics analysis, and investigate the potential influence of the gene in tumor microenvironment (TME).Methods: AML samples of genes were retrieved from The Cancer Genome Atlas (TCGA) databases. The number of tumor-infiltrating immune cells (TIC) as well as immune and stromal components in AML cases was calculated using the ESTIMATE and CIBERSORT algorithms. Two methods, COX regression analysis and protein-protein interaction (PPI) network, were applied to obtain related genes, and the intersection of related genes was taken to obtain differentially expressed genes (DEGs). Gene Set Enrichment Analysis (GSEA) was used for explore the biological signaling pathway. CIBERSORT analysis for the proportion of TICs was performed to reveal that TICs which are related of the target gene.Results: Cross-tabulation analysis of univariate COX regression analysis and PPI network known the β2 integrin factor (ITGB2) as a major predictor of AML prognosis. High expression of ITGB2 was correlated with low survival of AML patients. GSEA revealed that the higher the ITGB2 gene expression, the more active the immune-related activity. CIBERSORT analysis of the TICs ratio revealed that 9 kinds of TICs were negatively correlated with the expression of ITGB2, including CD4 memory resting T cells, CD8 T cells, naive B cells, resting NK cells, Plasma cells, follicular helper T cells, resting Mast cells, Eosinophils and activated mast cells. Only monocytes were positively correlated with ITGB2 expression. These results provided further evidence that ITGB2 levels may determine the prognosis of AML patients by modulating the immune status of TME, which provides an additional suggestion for the treatment of AML.

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High EVI1 Expression Predicts Adverse Outcomes in Children With De Novo Acute Myeloid Leukemia

Frontiers in Oncology ◽

10.3389/fonc.2021.712747 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yongzhi Zheng ◽

Yan Huang ◽

Shaohua Le ◽

Hao Zheng ◽

Xueling Hua ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Regression Analysis ◽

Myeloid Leukemia ◽

Pediatric Patients ◽

Cox Regression ◽

De Novo ◽

Adverse Outcomes ◽

Cox Regression Analysis ◽

Pediatric Aml ◽

Acute Myeloid

BackgroundA high ecotropic viral integration site 1 (EVI1) expression (EVI1high) is an independent prognostic factor in adult acute myeloid leukemia (AML). However, little is known of the prognostic value of EVI1high in pediatric AML. This study aimed to examine the biological and prognostic significance of EVI1high in uniformly treated pediatric patients with AML from a large cohort of seven centers in China.MethodsA diagnostic assay was developed to determine the relative EVI1 expression using a single real-time quantitative polymerase chain reaction in 421 newly diagnosed pediatric AML patients younger than 14 years from seven centers in southern China. All patients were treated with a uniform protocol, but only 383 patients were evaluated for their treatment response. The survival data were included in the subsequent analysis (n = 35 for EVI1high, n = 348 for EVI1low).ResultsEVI1high was found in 9.0% of all 421 pediatric patients with de novo AML. EVI1high was predominantly found in acute megakaryoblastic leukemia (FAB M7), MLL rearrangements, and unfavorable cytogenetic aberrance, whereas it was mutually exclusive with t (8; 21), inv (16)/t (16; 16), CEBPA, NPM1, or C-KIT mutations. In the univariate Cox regression analysis, EVI1high had a significantly adverse 5-year event-free survival (EFS) and overall survival (OS) [hazard ratio (HR) = 1.821 and 2.401, p = 0.036 and 0.005, respectively]. In the multivariate Cox regression analysis, EVI1high was an independent prognostic factor for the OS (HR = 2.447, p = 0.015) but not EFS (HR = 1.556, p = 0.174). Furthermore, EVI1high was an independent adverse predictor of the OS and EFS of patients with MLL rearrangements (univariate analysis: HR = 9.921 and 7.253, both p < 0.001; multivariate analysis: HR = 7.186 and 7.315, p = 0.005 and 0.001, respectively). Hematopoietic stem cell transplantation (HSCT) in first complete remission (CR1) provided EVI1high patients with a tendential survival benefit when compared with chemotherapy as a consolidation (5-year EFS: 68.4% vs. 50.8%, p = 0.26; 5-year OS: 65.9% vs. 54.8%, p = 0.45).ConclusionIt could be concluded that EVI1high can be detected in approximately 10% of pediatric AML cases. It is predominantly present in unfavorable cytogenetic subtypes and predicts adverse outcomes. Whether pediatric patients with EVI1high AML can benefit from HSCT in CR1 needs to be researched further.

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Construction of Immune-Related Prognostic Signatures in Acute Myeloid Leukemia

10.21203/rs.3.rs-51235/v1 ◽

2020 ◽

Author(s):

Ruyi Xu ◽

Yi Li ◽

Yang Liu ◽

Jianwei Qu ◽

Wen Cao ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

High Risk ◽

Myeloid Leukemia ◽

Cox Regression ◽

Risk Group ◽

Early Stage ◽

Chemotherapy Resistance ◽

High Risk Group ◽

Cox Regression Analysis ◽

Acute Myeloid

Abstract Background: Acute Myeloid Leukemia (AML) is characterized as a type of hematological malignancy with poor survival. Accumulated evidence showed that dysregulated immune activities contribute to the pathogenesis of AML and accelerate the development of chemotherapy resistance. Thus, we aimed to construct prognostic signatures based on patients’ immune features to sort out the high-risk group and to identify survival-related checkpoint molecules as potential therapeutic targets.Methods: In the current study, we developed two prognostic signatures based on immune genes and infiltrated fraction of immune cells, respectively, using a least absolute shrinkage and selection operator model, and Cox regression analysis on 415 samples obtained from TCGA and GEO databases. Results: We found the optimum strategy for predicting patients’ survival is combined using these two prognostic immune-related signatures. Through our established signatures, we classified patients into Favorable Risk group and Poor Risk group, who showed significantly different OS and DFS. We further demonstrated the checkpoint molecules’ profile in different risk groups. Conclusions: we constructed a powerful prognostic tool here to help classify high-risk patients in early-stage, who may benefit from additional immune therapies by targeting identified checkpoint molecules.

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Mutant DNMT3A: a marker of poor prognosis in acute myeloid leukemia

Blood ◽

10.1182/blood-2011-07-367961 ◽

2012 ◽

Vol 119 (24) ◽

pp. 5824-5831 ◽

Cited By ~ 165

Author(s):

Ana Flávia Tibúrcio Ribeiro ◽

Marta Pratcorona ◽

Claudia Erpelinck-Verschueren ◽

Veronika Rockova ◽

Mathijs Sanders ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Myeloid Leukemia ◽

Cox Regression ◽

Multivariable Analysis ◽

Gene Expression Signature ◽

Mutation Status ◽

Cox Regression Analysis ◽

Prognostic Effect ◽

Or Gene ◽

Acute Myeloid

Abstract The prevalence, the prognostic effect, and interaction with other molecular markers of DNMT3A mutations was studied in 415 patients with acute myeloid leukemia (AML) younger than 60 years. We show mutations in DNMT3A in 96 of 415 patients with newly diagnosed AML (23.1%). Univariate Cox regression analysis showed that patients with DNMT3Amutant AML show significantly worse overall survival (OS; P = .022; hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.04-1.81), and relapse-free survival (RFS; P = .005; HR, 1.52; 95% CI, 1.13-2.05) than DNMT3Awild-type AMLs. In a multivariable analysis, DNMT3A mutations express independent unfavorable prognostic value for OS (P = .003; HR, 1.82; 95% CI, 1.2-2.7) and RFS (P < .001; HR, 2.2; 95% CI, 1.4-3.3). In a composite genotypic subset of cytogenetic intermediate-risk AML without FLT3-ITD and NPM1 mutations, this association is particularly evident (OS: P = .013; HR, 2.09; 95% CI, 1.16-3.77; RFS: P = .001; HR, 2.65; 95% CI, 1.48-4.89). The effect of DNMT3A mutations in human AML remains elusive, because DNMT3Amutant AMLs did not express a methylation or gene expression signature that discriminates them from patients with DNMT3Awild-type AML. We conclude that DNMT3A mutation status is an important factor to consider for risk stratification of patients with AML.

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Expression Levels of Human Equilibrative Nucleoside Transporter 1 and Deoxycytidine Kinase Enzyme as Prognostic Factors in Patients with Acute Myeloid Leukemia Treated with Cytarabine

Chemotherapy ◽

10.1159/000445370 ◽

2016 ◽

Vol 61 (6) ◽

pp. 313-318 ◽

Cited By ~ 4

Author(s):

Myrna Candelaria ◽

Carmen Corrales-Alfaro ◽

Olga Gutiérrez-Hernández ◽

José Díaz-Chavez ◽

Juan Labardini-Méndez ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Myeloid Leukemia ◽

Cox Regression ◽

Performance Status ◽

Deoxycytidine Kinase ◽

Nucleoside Transporter ◽

Cox Regression Analysis ◽

Expression Levels ◽

Equilibrative Nucleoside Transporter ◽

Acute Myeloid

Background: Cytarabine (Ara-C) is the primary drug in different treatment schemas for acute myeloid leukemia (AML) and requires the human equilibrative nucleoside transporter (hENT1) to enter cells. The deoxycytidine kinase (dCK) enzyme limits its activation rate. Therefore, decreased expression levels of these genes may influence the response rate to this drug. Methods: AML patients without previous treatment were enrolled. The expression of hENT1 and dCK genes was analyzed using RT-PCR. Clinical parameters were registered. All patients received Ara-C + doxorubicin as an induction regimen (7 + 3 schema). Descriptive statistics were used to analyze data. Uni- and multivariate analyses were performed to determine factors that influenced response and survival. Results: Twenty-eight patients were included from January 2011 until December 2012. Median age was 36.5 years. All patients had an adequate performance status (43% with ECOG 1 and 57% with ECOG 2). Cytogenetic risk was considered unfavorable in 54% of the patients. Complete response was achieved in 53.8%. Cox regression analysis showed that a higher hENT1 expression level was the only factor that influenced response and survival. Conclusions: These results highly suggest that the pharmacogenetic analyses of Ara-C influx may be decisive in AML patients.

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High Expression of PXN Predicts a Poor Prognosis in Acute myeloid leukemia

10.21203/rs.3.rs-847908/v1 ◽

2021 ◽

Author(s):

xinwen zhang ◽

Hao Xiong ◽

Jialin Duan ◽

Xiaomin Chen ◽

Yang Liu ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Myeloid Leukemia ◽

Poor Prognosis ◽

Cox Regression ◽

Prognostic Significance ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Receive Treatment ◽

To Receive ◽

Acute Myeloid

Abstract Background: Acute myeloid leukemia (AML) is one of the common malignant diseases of hematopoietic system. Paxillin ( PXN ) is an important part of focal adhesions (FAs), which is related to the poor prognosis of many kinds of malignant tumors. However, no research has focused on the expression of PXN in AML. We aimed to investigate the expression of PXN in AML and its prognostic significance. Methods: Using GEPIA and UALCAN database to analyze the expression of PXN in AML patients and its prognostic significance. Bone marrow samples of newly diagnosed AML patients were collected to extract RNA, and qRT-PCR was used to detect the expression of PXN . The prognosis was followed up. Chi-square test was used to analyze the relationship between PXN expression and clinical laboratory characteristics. Kaplan-Meier analysis was used to draw survival curve, and Cox regression analysis was used to analyze the independent factors affecting the prognosis of patients with AML. The co-expression genes of PXN were analyzed by LinkedOmics to explore its biological significance in AML. Results: Kaplan-Meier analysis showed that the overall survival time of AML patients was related to whether to receive treatment and PXN expression(P<0.05). COX regression analysis showed that whether to receive treatment (HR=0.227，95%CI=0.075-0.689， P =0.009) and high expression of PXN (HR=4.484，95%CI=1.449-13.889， P =0.009) were independent poor prognostic factors in patients with AML. Conclusion: PXN is highly expressed in AML patient, and high PXN expression is an indicator of poor prognosis in AML patient.

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A three-gene signature might predict prognosis in patients with acute myeloid leukemia

Bioscience Reports ◽

10.1042/bsr20193808 ◽

2020 ◽

Vol 40 (6) ◽

Author(s):

Xin Zhu ◽

Qian Zhao ◽

Xiaoyu Su ◽

Jinming Ke ◽

Yunyun Yi ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Transcription Factor ◽

High Risk ◽

Myeloid Leukemia ◽

Cox Regression ◽

Risk Group ◽

White Blood Cells ◽

Gene Signature ◽

Low Risk ◽

Acute Myeloid

Abstract The identification of effective signatures is crucial to predict the prognosis of acute myeloid leukemia (AML). The investigation aimed to identify a new signature for AML prognostic prediction by using the three-gene expression (octamer-binding transcription factor 4 (OCT4), POU domain type 5 transcription factor 1B (POU5F1B) and B-cell-specific Moloney murine leukemia virus integration site-1 pseudogene 1 (BMI1P1). The expressions of genes were obtained from our previous study. Only the specimens in which three genes were all expressed were included in this research. A three-gene signature was constructed by the multivariate Cox regression analyses to divide patients into high-risk and low-risk groups. Receiver operating characteristic (ROC) analysis of the three-gene signature (area under ROC curve (AUC) = 0.901, 95% CI: 0.821–0.981, P<0.001) indicated that it was a more valuable signature for distinguishing between patients and controls than any of the three genes. Moreover, white blood cells (WBCs, P=0.004), platelets (PLTs, P=0.017), percentage of blasts in bone marrow (BM) (P=0.011) and complete remission (CR, P=0.027) had significant differences between two groups. Furthermore, high-risk group had shorter leukemia-free survival (LFS) and overall survival (OS) than low-risk group (P=0.026; P=0.006), and the three-gene signature was a prognostic factor. Our three-gene signature for prognosis prediction in AML may serve as a prognostic biomarker.

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Rebound Thrombocytosis following Induction Chemotherapy Is an Independent Predictor of a Good Prognosis in Acute Myeloid Leukemia Patients Attaining First Complete Remission

Acta Haematologica ◽

10.1159/000369917 ◽

2015 ◽

Vol 134 (1) ◽

pp. 32-37 ◽

Cited By ~ 6

Author(s):

Umit Yavuz Malkan ◽

Gursel Gunes ◽

Ayse Isik ◽

Eylem Eliacik ◽

Sezgin Etgul ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Myeloid Leukemia ◽

Recovery Time ◽

Cox Regression ◽

De Novo ◽

Statistical Significance ◽

Good Prognosis ◽

Platelet Recovery ◽

Cox Regression Analysis ◽

Acute Myeloid

There are very few data about the relationship between acute myeloid leukemia (AML) prognosis and bone marrow recovery kinetics following chemotherapy. In this study, we aimed to assess the prognostic importance and clinical associations of neutrophil and platelet recovery rates and rebound thrombocytosis (RT) or neutrophilia (RN) in the postchemotherapy period for newly diagnosed AML patients. De novo AML patients diagnosed between October 2002 and December 2013 were evaluated retrospectively. One hundred patients were suitable for inclusion. Cox regression analysis using need for reinduction chemotherapy as a stratification parameter revealed RT as the only parameter predictive of OS, with borderline statistical significance (p = 0.06, OR = 7; 95% CI 0.92-53), and it was the only parameter predictive of DFS (p = 0.024, OR = 10; 95% CI 1.3-75). In order to understand whether RT or RN was related to a better marrow capacity or late consolidation, we considered neutrophil recovery time and platelet recovery time and nadir-first consolidation durations in all patients in the cohort. Both the marrow recovery duration and the time between marrow aplasia and first consolidation were shorter in RT and RN patients. To our knowledge, this is the first study to report a correlation between RT/RN and prognosis in AML.

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