title: Mutation of the Wilms' tumor 1 gene is a poor prognostic factor associated with chemotherapy resistance in normal karyotype acute myeloid leukemia: the United Kingdom Medical Research Council Adult Leukaemia Working Party.
abstract: OBJECTIVE
  To determine the clinical relevance of Wilms' tumor 1 (WT1) gene mutations in acute myeloid leukemia (AML) with normal karyotype (NK).
  
  
  METHODS
  Exons 7 and 9 of WT1 were screened in samples from 470 young adult NK AMLs using a combination of direct sequencing and high-resolution capillary electrophoresis.
  
  
  RESULTS
  Overall, 51 mutations were detected in 47 cases (10%): 46 frameshift mutations with insertion/deletion of one to 28 base pairs in exon 7 (n = 45) or exon 9 (n = 1), with a median mutant level of 45% (range, 8% to 86%), and five substitutions in exon 9: D396N (n = 3), H397Y (n = 1) and H397Q (n = 1). Patients with WT1 mutations had an inferior response to induction chemotherapy compared with wild-type cases (complete remission rate, 79% v 90%, odds ratio [OR] = 3.02; 95% CI, 1.17 to 7.82; P = .02), a higher rate of resistant disease (15% v 4%; OR = 9.33; 95% CI, 2.38 to 36.6; P = .001), an increased cumulative incidence of relapse (67% v 43%, hazard ratio [HR] = 3.02; 95% CI, 1.69 to 5.38; P = .0008), with a reduction in both relapse-free survival (22% v 44%; HR = 2.16; 95% CI, 1.32 to 3.55; P = .005) and overall survival (26% v 47%; HR = 1.91; 95% CI, 1.23 to 2.95; P = .007) at 5 years. In multivariate analysis, which included FLT3 internal tandem duplication and NPM1 mutation status, the presence of a WT1 mutation remained an independent adverse prognostic factor.
  
  
  CONCLUSIONS
  WT1 mutations are a negative prognostic indicator in NK AML and may be suitable for the development of targeted therapy.
authors.affiliation: Centre for Medical Oncology, Institute of Cancer, Barts and the London School of Medicine, Charterhouse Square, London, UK.
authors.forename: Priya
authors.initials: P
authors.lastname: Virappane
authors.forename: Rosemary
authors.initials: R
authors.lastname: Gale
authors.forename: Robert
authors.initials: R
authors.lastname: Hills
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kakkas
authors.forename: Karin
authors.initials: K
authors.lastname: Summers
authors.forename: Jane
authors.initials: J
authors.lastname: Stevens
authors.forename: Christopher
authors.initials: C
authors.lastname: Allen
authors.forename: Claire
authors.initials: C
authors.lastname: Green
authors.forename: Hilmar
authors.initials: H
authors.lastname: Quentmeier
authors.forename: Hans
authors.initials: H
authors.lastname: Drexler
authors.forename: Alan
authors.initials: A
authors.lastname: Burnett
authors.forename: David
authors.initials: D
authors.lastname: Linch
authors.forename: Dominique
authors.initials: D
authors.lastname: Bonnet
authors.forename: T Andrew
authors.initials: TA
authors.lastname: Lister
authors.forename: Jude
authors.initials: J
authors.lastname: Fitzgibbon
mesh_terms: D000293:Adolescent; D000328:Adult; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm / Q000235:genetics*; D005091:Exons / Q000235:genetics; D005260:Female; D016162:Genes, Wilms Tumor; D006801:Humans; D007621:Karyotyping; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000235:genetics* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009154:Mutation; D000090243:Nucleophosmin; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult