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Evaluation by Multivariate Analysis of the Differentiation Inhibitory
Factor nm23 as a Prognostic Factor in Acute Myelogenous
Leukemia and Application to Other Hematologic Malignancies
Akihiro Yokoyama,
Junko Okabe-Kado,
Naoki Wakimoto,
Hirofumi Kobayashi,
Akiko Sakashita,
Nobuo Maseki,
Tsuyoshi Nakamaki,
Ken-ichiro Hino,
Shigeru Tomoyasu,
Nobuyoshi Tsuruoka,
Kazuo Motoyoshi,
Naokazu Nagata, and
Yoshio Honma
From the Department of Chemotherapy, Research Institute and
Hematology Clinic, Hospital, Saitama Cancer Center, Saitama, Japan; the
Department of Hematology, Showa University School of Medicine, Tokyo,
Japan; and the Third Department of Internal Medicine, National Defense
Medical College, Saitama, Japan.
The differentiation inhibitory factor nm23 can inhibit the
differentiation of murine and human myeloid leukemia cells. We recently
reported that nm23 genes were overexpressed in acute myelogenous leukemia (AML), and a higher level of nm23-H1
expression was correlated with a poor prognosis in AML, especially in
AML-M5 (acute monocytic leukemia). To evaluate the importance of
nm23 expression as a prognostic factor in AML, we compared it
with other putative prognostic factors in AML. An analysis of the
correlation between nm23 expression and the clinical parameters
of 110 patients with AML demonstrated that increased nm23-H1
mRNA levels were associated with resistance to initial chemotherapy and
with reduced overall survival. Multivariate analysis using Cox's
proportional hazard model also showed that elevated nm23-H1
mRNA levels significantly contributed to the prognosis of patients with
AML. Especially in AML-M5, nm23-H1 status was the most
important prognostic factor. Furthermore, to determine whether we can
apply the results observed in AML to other hematologic malignancies, we
investigated the relative levels of nm23-H1 and nm23-H2
transcripts in 149 patients with hematologic neoplasms, including 110 with de novo AML, 9 with de novo acute lymphoblastic leukemia, 14 with
myelodysplastic syndrome, 16 with chronic myelogenous leukemia (CML),
and 5 normal subjects by the reverse transcriptase-polymerase chain
reaction. Expression of nm23-H1 was significantly higher in all
the hematologic neoplasms, except CML in chronic phase, than in normal
blood cells. nm23 may have a prognostic effect in these
hematologic malignancies as well as in AML.
Blood, Vol. 91 No. 6 (March 15), 1998:
pp. 1845-1851
© 1998 by The American Society of Hematology.
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