@article{Hagag_2016, title={PROGNOSTIC IMPACT OF WT-1 GENE EXPRESSION IN EGYPTIAN CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA}, volume={8}, url={https://www.mjhid.org/mjhid/article/view/2016.008}, DOI={10.4084/mjhid.2016.008}, abstractNote={<p class="MsoNormal" style="margin-bottom: 6.0pt; text-align: justify; text-justify: inter-ideograph; text-indent: 14.2pt; line-height: normal; direction: ltr; unicode-bidi: embed;"><strong><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi;">Background:</span></strong><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi;"> Acute lymphoblastic leukemia (ALL) is the most common childhood cancer representing 23% of pediatric cancers. Wilms’ tumor -1 gene has is a novel prognostic factor, minimal residual disease marker and therapeutic target in acute leukemia. <strong>Aim of the work:</strong> The aim of this work was to study the impact of WT-1 gene expression in prognosis of Egyptian children with ALL.<strong> Patients and methods:</strong> This study was conducted on 40 children with newly diagnosed ALL who were subjected to full history taking, thorough clinical examination and laboratory investigations including; complete blood count, LDH, BM aspiration, cytochemistry, immunophenotyping, assessment of WT-1 Gene by real time PCR in BM samples at time of diagnosis<strong>. Results:</strong> Positive </span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: SimSun; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-language: ZH-CN; mso-bidi-language: AR-EG;">WT-1 gene expression</span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi;"> was found in 22 cases (55%) and negative expression in 18 cases (45%)</span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: SimSun; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-language: ZH-CN; mso-bidi-language: AR-EG;">. </span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-EG;">Positive </span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: SimSun; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-language: ZH-CN; mso-bidi-language: AR-EG;">WT-1 gene expression</span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-EG;"> group (n=22) includes 14 males and 8 females with mean age at presentation of </span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi;">5.261 ± 0.811</span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-EG;"> while negative </span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: SimSun; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-language: ZH-CN; mso-bidi-language: AR-EG;">WT-1 gene expression</span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-EG;"> group (n=18) includes 12 males and 6 females with mean age at </span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: SimSun; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-language: ZH-CN; mso-bidi-language: AR-EG;">diagnosis</span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-EG;"> of </span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi;">9.669 ± 3.731</span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: SimSun; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-language: ZH-CN; mso-bidi-language: AR-EG;"> with significantly older age in negative WT-1 gene expression group but</span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi;"> no significant differences between positive and negative WT-1 gene expression groups regarding sex and clinical presentations. There were no significant differences in platelets and WBCs counts, hemoglobin </span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; letter-spacing: .75pt;">and LDH levels</span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi;"> and number of </span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; letter-spacing: .75pt;">peripheral blood and </span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi;">BM blast cells at diagnosis between positive and negative WT-1 gene expression groups but after induction therapy there were significantly lower BM blast cells in positive WT-1 gene expression group</span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi;">. There were no statistically significant differences</span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi;"> between </span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-EG;">positive </span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi;">and negative WT-1 gene expression </span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-EG;">groups </span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi;">regarding immunophenotyping</span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: SimSun; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-language: ZH-CN; mso-bidi-language: AR-EG;">.</span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: ’Times New Roman’; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-language: AR-SA;"> There were significantly higher relapse and death rates and lower rates of CR,<span style="mso-font-width: 102%;"> DFS </span>and OAS in</span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: ’Times New Roman’; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi;"> negative</span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi;">WT-1 </span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi;">gene </span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: ’Times New Roman’; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi;">expression group.MRD at end of induction therapy was found in 14 cases out of 40 patients. </span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi;">There was significantly higher number of cases with MRD in negative WT-1 gene expression</span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: SimSun; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-language: ZH-CN; mso-bidi-language: AR-EG;"> group (</span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi;">In 26 cases with negative MRD; 20 have positive WT-1 gene expression and 6 have negative WT-1gene expression while in 14 cases with positive MRD ; 12 cases showed negative WT-1 gene expression and 2 cases showed positive WT-1 gene expression) </span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: SimSun; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-language: ZH-CN; mso-bidi-language: AR-EG;">(p value = </span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-language: ZH-CN; mso-bidi-language: AR-EG;">0.006)</span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: ’Times New Roman’; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-language: AR-SA;">.</span><span style="font-size: 12.0pt; font-family: ’Times New Roman’,’serif’; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi;"> <strong>Conclusions and</strong> <strong>Recommendation:</strong> WT-1 gene expression is important prognostic factor in patients with ALL and therefore we recommend its incorporation into novel risk-adapted therapeutic strategies in patients with ALL.</span></p>}, journal={Mediterranean Journal of Hematology and Infectious Diseases}, author={Hagag, Adel Abd Elhaleim}, year={2016}, month={Jan.}, pages={e2016008} }