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Blood, 15 August 2007, Vol. 110, No. 4, pp. 1291-1300. Prepublished online as a Blood First Edition Paper on May 7, 2007; DOI 10.1182/blood-2006-10-049783.
NEOPLASIA Gene-expression profiling identifies distinct subclasses of core binding factor acute myeloid leukemia1 Department of Internal Medicine III, University of Ulm, Ulm, Germany; 2 Department of Physiological Chemistry, University of Ulm, Ulm, Germany; 3 Department for Computational Molecular Biology, Max-Planck-Institute for Molecular Genetics, Berlin, Germany; 4 Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; and 5 Department of Pathology, Stanford University, Palo Alto, CA Core binding factor (CBF) leukemias, characterized by either inv(16)/t(16;16) or t(8;21), constitute acute myeloid leukemia (AML) subgroups with favorable prognosis. However, there exists substantial biologic and clinical heterogeneity within these cytogenetic groups that is not fully reflected by the current classification system. To improve the molecular characterization we profiled gene expression in a large series (n = 93) of AML patients with CBF leukemia [(inv (16), n = 55; t(8;21), n = 38)]. By unsupervised hierarchical clustering we were able to define a subgroup of CBF cases (n = 35) characterized by shorter overall survival times (P = .03). While there was no obvious correlation with fusion gene transcript levels, FLT3 tyrosine kinase domain, KIT, and NRAS mutations, the newly defined inv(16)/t(8;21) subgroup was associated with elevated white blood cell counts and FLT3 internal tandem duplications (P = .011 and P = .026, respectively). Supervised analyses of gene expression suggested alternative cooperating pathways leading to transformation. In the "favorable" CBF leukemias, antiapoptotic mechanisms and deregulated mTOR signaling and, in the newly defined "unfavorable" subgroup, aberrant MAPK signaling and chemotherapy-resistance mechanisms might play a role. While the leukemogenic relevance of these signatures remains to be validated, their existence nevertheless supports a prognostically relevant biologic basis for the heterogeneity observed in CBF leukemia.
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