title: Prognostic significance of the BAALC isoform pattern and CEBPA mutations in pediatric acute myeloid leukemia with normal karyotype: a study by the Japanese Childhood AML Cooperative Study Group.
abstract: High BAALC (brain and acute leukemia, cytoplasmic) gene expression may indicate an adverse prognosis for adults who have acute myeloid leukemia (AML) and a normal karyotype, but its prognostic significance for pediatric AML cases is unclear. Whether different BAALC isoform patterns are of prognostic significance is also unclear. Newly diagnosed AML patients with normal karyotype who were treated by the Japanese Childhood AML Cooperative Treatment Protocol AML 99 were analyzed in terms of their BAALC expression levels (n = 29), BAALC isoforms (n = 29), and CEBPA mutations (n = 49). Eleven and 18 patients exhibited high and low BAALC expression, respectively, but these groups did not differ significantly in terms of overall survival (54.6 vs. 61.1%, P = 0.55) or event-free survival (61.4 vs. 50.0%, P = 0.82). Three of these 29 patients (10.3%) expressed the exon 1-5-6-8 BAALC isoform along with the expected 1-6-8 isoform and had adverse clinical outcomes. Novel CEBPA mutations were also identified in four of 49 patients (8.2%). All four patients have maintained complete remission for at least 5 years. Thus, 1-5-6-8 isoform expression may be associated with an adverse prognosis in pediatric AML with normal karyotype. CEBPA mutations may indicate a favorable prognosis.
authors.affiliation: Department of Pediatrics, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Syogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Mizushima
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Taki
authors.forename: Akira
authors.initials: A
authors.lastname: Shimada
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Yui
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Hiraumi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsubara
authors.forename: Motonobu
authors.initials: M
authors.lastname: Watanabe
authors.forename: Ken-ichiro
authors.initials: K
authors.lastname: Watanabe
authors.forename: Yuri
authors.initials: Y
authors.lastname: Kamitsuji
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Ichiro
authors.initials: I
authors.lastname: Tsukimoto
authors.forename: Ryoji
authors.initials: R
authors.lastname: Kobayashi
authors.forename: Keizo
authors.initials: K
authors.lastname: Horibe
authors.forename: Akio
authors.initials: A
authors.lastname: Tawa
authors.forename: Tatsutoshi
authors.initials: T
authors.lastname: Nakahata
authors.forename: Souichi
authors.initials: S
authors.lastname: Adachi
mesh_terms: D000293:Adolescent; D044466:Asian People / Q000235:genetics*; D022762:CCAAT-Enhancer-Binding Proteins / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D005260:Female; D015973:Gene Expression Regulation, Leukemic; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007621:Karyotyping; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis* / Q000235:genetics; D008297:Male; D009154:Mutation; D009363:Neoplasm Proteins / Q000235:genetics; D011379:Prognosis; D020033:Protein Isoforms / Q000235:genetics
chemical_list: C442828:BAALC protein, human; D022762:CCAAT-Enhancer-Binding Proteins; C515848:CEBPA protein, human; D009363:Neoplasm Proteins; D020033:Protein Isoforms