Use of Gene-Expression Profiling to Identify Prognostic Subclasses in Adult Acute Myeloid Leukemia

• Published in: The New England journal of medicine Vol. 350; no. 16; pp. 1605 - 1616
• Main Authors: Bullinger, Lars, Döhner, Konstanze, Döhner, Hartmut, Bair, Eric, Fröhling, Stefan, Schlenk, Richard F, Tibshirani, Robert, Pollack, Jonathan R
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 15.04.2004
• Subjects: Acute Disease; Adult; Algorithms; Biological and medical sciences; Chromosome Aberrations; Clinical outcomes; Cluster Analysis; Gene Expression; Gene Expression Profiling - methods; General aspects; Genes; Hematologic and hematopoietic diseases; Humans; Karyotyping; Leukemia; Leukemia, Myeloid - classification; Leukemia, Myeloid - genetics; Leukemia, Myeloid - mortality; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Medical sciences; Medical treatment; Multivariate Analysis; Mutation; Oligonucleotide Array Sequence Analysis - methods; Prognosis; Risk Assessment - methods; Survival Analysis; Human; Medicine; Prognosis; Acute; Adult; Malignant hemopathy; Identification; Acute myelocytic leukemia; Gene expression profile
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa031046

This study demonstrates that the genes expressed by peripheral-blood monocytes of adults with acute myeloid leukemia provide prognostic information over and above that provided by established indicators such as cytogenetic status. The authors analyzed the gene-expression profiles of samples obtained from 116 patients, who were subsequently assigned to receive various intensive treatments. They identified good- and poor-outcome classes of gene expression that were associated with differences in overall survival — even when the analysis was restricted to specimens with a normal karyotype. Genes expressed by monocytes identified good- and poor-outcome classes even with a normal karyotype. Acute myeloid leukemia (AML) is the most common acute leukemia in adults. Chemotherapy induces a complete remission in 70 to 80 percent of younger patients (age, 16 to 60 years), but many of them have a relapse and die of their disease. Myeloablative conditioning followed by allogeneic stem-cell transplantation can prevent relapse, but this approach is associated with a high treatment-related mortality. 1 Therefore, accurate predictors of the clinical outcome are needed to determine appropriate treatment for individual patients. (See Glossary.) Currently used prognostic indicators include age, cytogenetic findings, the white-cell count, and the presence or absence of an antecedent hematologic . . .