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Blood, 2 July 2009, Vol. 114, No. 1, pp. 148-152.
Prepublished online as a Blood First Edition Paper on April 27, 2009; DOI 10.1182/blood-2008-11-187724.
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Submitted November 5, 2008
Accepted March 25, 2009
Molecular stratification model for prognosis in cytogenetically normal acute myeloid leukemia (CN-AML)
Carlos M. Santamaria, Maria C. Chillon, Ramon Garcia-Sanz*, Cristina Perez, Maria D. Caballero, Fernando Ramos, Alfonso Garcia de Coca, Jose M. Alonso, Pilar Giraldo, Teresa Bernal, Jose A. Queizan, Juan N. Rodriguez, Pascual Fernandez-Abellan, Abelardo Barez, Maria J. Penarrubia, Ana Balanzategui, Maria B. Vidriales, Maria E. Sarasquete, Miguel Alcoceba, Joaquin Diaz-Mediavilla, Jesus F. San Miguel, and Marcos Gonzalez
Hospital Universitario, Salamanca, Spain
Centro de Investigacion del Cancer-IBMCC (USAL-CSIC) of Salamanca, Salamanca, Spain
Hospital Clinico San Carlos, Madrid, Spain
Complejo Hospitalario de Leon, Leon, Spain
Hospital Clinico de Valladolid, Valladolid, Spain
Hospital Rio Carrion de Palencia, Palencia, Spain
Hospital Miguel Servet, Zaragoza, Spain
Hospital Central de Asturias, Oviedo, Spain
Hospital General de Segovia, Segovia, Spain
Hospital Juan Ramon Jimenez, Huelva, Spain
Hospital Universitario de Alicante, Alicante, Spain
Hospital Nuestra Senora de Sonsoles, Avila, Spain
Hospital Rio Hortega, Valladolid, Spain
* Corresponding author; email: rgarcias{at}usal.es.
We have evaluated nine new molecular markers (ERG, EVI1, MLL-PTD, MN1, PRAME, RHAMM, and WT1 gene expression levels plus FLT3 and NPM1 mutations) in 121 de-novo cytogenetically normal acute myeloblastic leukemias (CN-AML). In the multivariate analysis, high ERG or EVI1 and low PRAME expressions were associated with shorter relapse free and overall survival (RFS & OS). A 0 to 3 score was given by assigning a value of 0 to favorable parameters (low ERG, low EVI1 and high PRAME) and 1 to adverse parameters. This model distinguished four subsets of patients with different OS (2-yr OS of 79%, 65%, 46% and 27%; p=0.001) and RFS (2-yr RFS of 92%, 65%, 49% and 43%; p=0.005). Furthermore, this score identified patients with different OS (p=0.001) and RFS (p=0.013) even within the FLT3/NPM1 intermediate/high-risk subgroups. Here we propose a new molecular score for CN-AML which could improve patient risk-stratification.

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