Submitted July 7, 2006
Accepted August 30, 2006
Expression of Livin, an anti-apoptotic protein, is an
independent favorable prognostic factor in childhood
acute lymphoblastic leukemia
Jaewon Choi, Yu Kyeong Hwang, Ki Woong Sung*, Soo Hyun Lee, Keon Hee Yoo, Hye Lim Jung, Hong Hoe Koo, Hee-Jin Kim, Hyung Jin Kang, Hee Young Shin, and Hyo Seop Ahn
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan Univ School of Medicine, Seoul, Korea
Division of Immunotherapy, Mogam Biotechnology Research Institute, Yongin, Korea
Dept. of Laboratory Medicine, Samsung Medical Center, Seoul, Korea
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
* Corresponding author; email: kwsped{at}smc.samsung.co.kr.
Livin, a member of the inhibitor of apoptosis proteins, has been considered to be a poor prognostic marker in malignancies. However, little is known about the clinical relevance of Livin expression in childhood ALL. In this study, the expression of Livin was analyzed in 222 childhood ALL using quantitative RT-PCR to investigate a possible association with the clinical features at diagnosis and treatment outcomes. Both Livin expression rates and expression levels were higher in patients with favorable prognostic factors. The expression rate was also higher in patients with a favorable day 7 bone marrow response to induction chemotherapy (P < .001). The Livin expression was related to the absence of relapse (P < .001). Similarly, the relapse-free survival rate (± 95% CI) was higher in patients with Livin expression than in patients without Livin expression (97.9 ± 4.0% versus 64.9 ± 11.8%, P < .001). Multivariate analysis for relapse-free survival demonstrated that Livin expression was an independent favorable prognostic factor in childhood ALL (P = .049). This study suggests that Livin expression is a novel prognostic marker in childhood ALL and thus needs to be incorporated into the patient stratification and treatment protocols.
