High WT1 expression is an early predictor for relapse in patients with acute promyelocytic leukemia in first remission with negative PML-RARa after anthracycline-based chemotherapy: a single-center cohort study

摘要

AbstractWilms’ tumor gene 1 ( WT1 ) expression is a well-known predictor for relapse in acute myeloid leukemia. We monitored WT1 decrement along the treatment course to identify its significant role as a marker for residual disease in acute promyelocytic leukemia (APL) and tried to suggest its significance for relapse prediction. In this single center retrospective study, we serially measured PML-RARa and WT1 expression from 117 APL patients at diagnosis, at post-induction and post-consolidation chemotherapies, and at every 3?months after starting maintenance therapy. All 117 patients were in molecular remission after treatment of at least 2 consolidation chemotherapies. We used WT1 ProfileQuant? kit (Ipsogen) for WT1 monitoring. High WT1 expression (>120 copies/104 ABL1 ) after consolidation and at early period (3?months) after maintenance therapy significantly predicted subsequent relapse. All paired PML-RARa RQ-PCR were not detected except for one sample with early relapse. Patients with high WT1 expression at 3?months after maintenance therapy ( n =?40) showed a significantly higher relapse rate (30.5 vs. 6.9%, P P P WT1 expression at 3?months after maintenance therapy (HR?=?7.1, P WT1 expression was a reliable marker for prediction of subsequent molecular relapse in APL. In this high-risk group, early intervention with ATRA?±?ATO, anti-CD33 antibody therapy, and WT1 -specific therapy may be used for relapse prevention. Trial registrationClinical Research Information Service (CRIS), KCT0002079