title: Leukaemia relapse after allogeneic transplants for acute myeloid leukaemia: predictive role of WT1 expression.
abstract: We assessed WT1 expression (expressed as messenger copies/10(4) ABL1) from marrow cells of 122 patients with acute myeloid leukaemia (AML), before and after an unmanipulated allogeneic haemopoietic stem cell transplant (HSCT). The median age was 44 years (15-69), 59% were in first remission, 74% received a myeloablative conditioning regimen and the median follow up was 865 d (34-2833). Relapse was higher in 67 patients with WT1 expression, at any time post-HSCT, exceeding 100 copies (54%), as compared to 16%, for 55 patients with post-HSCT WT1 expression <100 copies (P < 0·0001). Similarly, actuarial 5-year survival (OS) was 40% vs. 63%, respectively (P = 0·03). In multivariate Cox analysis, WT1 expression post-HSCT was the strongest predictor of relapse (Hazard Ratio [HR] 4·5, P = 0·0001), independent of disease phase (HR 2·3, P = 0·002). Donor lymphocyte infusions (DLI) were given to 17 patients because of increasing WT1 levels: their OS was 44%, vs. 14% for 21 patients with increasing WT1 expression who did not receive DLI (P = 0·004). In conclusion, WT1 expression post-HSCT is a strong predictor of leukaemia relapse and survival in AML; WT1 may be used as a marker for early interventional therapy.
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino-IST, Genova, Italy.
authors.forename: Sarah
authors.initials: S
authors.lastname: Pozzi
authors.forename: Simona
authors.initials: S
authors.lastname: Geroldi
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Tedone
authors.forename: Silvia
authors.initials: S
authors.lastname: Luchetti
authors.forename: Raffaella
authors.initials: R
authors.lastname: Grasso
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Colombo
authors.forename: Carmen
authors.initials: C
authors.lastname: Di Grazia
authors.forename: Teresa
authors.initials: T
authors.lastname: Lamparelli
authors.forename: Francesca
authors.initials: F
authors.lastname: Gualandi
authors.forename: Adalberto
authors.initials: A
authors.lastname: Ibatici
authors.forename: Stefania
authors.initials: S
authors.lastname: Bregante
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Van Lint
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Raiola
authors.forename: Alida
authors.initials: A
authors.lastname: Dominietto
authors.forename: Riccardo
authors.initials: R
authors.lastname: Varaldo
authors.forename: Alessio
authors.initials: A
authors.lastname: Signori
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacigalupo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015470:Leukemia, Myeloid, Acute / Q000378:metabolism / Q000628:therapy*; D017710:Lymphocyte Transfusion / Q000379:methods; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000378:metabolism*; D011182:Postoperative Care; D011300:Preoperative Care; D055502:Secondary Prevention; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D025721:WT1 Proteins / Q000378:metabolism*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D009363:Neoplasm Proteins; D025721:WT1 Proteins