title: BIRC6/Apollon gene expression in childhood acute leukemia: impact on therapeutic response and prognosis.
abstract: OBJECTIVE
  Although BIRC6/Apollon seems to play a critical role as an antiapoptotic regulator, its clinical relevance in acute leukemia remains largely elusive. Therefore, we aimed to investigate BIRC6 gene expression in childhood acute leukemia in relation to clinicopathological characteristics at presentation, therapeutic response, and prognosis.
  
  
  METHODS
  BIRC6 expression level was assessed in 75 children with acute leukemia; 30 patients with acute myeloblastic leukemia (AML) and 45 patients with acute lymphoblastic leukemia (ALL) using real-time quantitative reverse transcriptase-polymerase chain reaction.
  
  
  RESULTS
  The median level of BIRC6 expression did not differ significantly between AML and ALL patients. BIRC6 expression level was higher in patients with AML and ALL with extramedullary involvement, white blood cell (WBC) count ≥ 10 × 10(9) /L, and unfavorable cytogenetics at diagnosis. BIRC6 gene expression was higher in patients with unfavorable response to therapy at day 14, those who developed relapse or died in both leukemic groups. The best cutoff value of BIRC6 to predict therapeutic response and disease outcome was determined. AML and ALL patients with BIRC6 overexpression had significantly shorter overall and disease free survivals.
  
  
  CONCLUSIONS
  This is the first report to study BIRC6 gene in pediatric ALL. Our results suggested that BIRC6 gene expression could be considered as an adverse risk factor in childhood acute leukemia and, hence, could be used to guide therapeutic regimens.
authors.affiliation: Clinical Pathology Department, Ain Shams University, Cairo, Egypt.
authors.forename: Eman Abdel Rahman
authors.initials: EA
authors.lastname: Ismail
authors.forename: Hanan Mohamed
authors.initials: HM
authors.lastname: Mahmoud
authors.forename: Lamis Mohamed
authors.initials: LM
authors.lastname: Tawfik
authors.forename: Deena Mohamed
authors.initials: DM
authors.lastname: Habashy
authors.forename: Amira Abdel Moneam
authors.initials: AA
authors.lastname: Adly
authors.forename: Nayera Hazaa
authors.initials: NH
authors.lastname: El-Sherif
authors.forename: Mahmoud Ahmed
authors.initials: MA
authors.lastname: Abdelwahab
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D015870:Gene Expression; D015973:Gene Expression Regulation, Leukemic; D006801:Humans; D007223:Infant; D051034:Inhibitor of Apoptosis Proteins / Q000235:genetics*; D053208:Kaplan-Meier Estimate; D007938:Leukemia / Q000188:drug therapy* / Q000235:genetics* / Q000401:mortality; D008297:Male; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: C401541:BIRC6 protein, human; D051034:Inhibitor of Apoptosis Proteins