High expression of c-kit mRNA predicts unfavorable outcome in adult patients with t(8;21) acute myeloid leukemia

PLoS One. 2015 Apr 10;10(4):e0124241. doi: 10.1371/journal.pone.0124241. eCollection 2015.

Abstract

The reason that a certain subgroup of acute myeloid leukemia (AML) patients with t(8;21) translocation (generating the AML1/ETO fusion gene) displays a poor survival remains elusive. The proto-oncogene c-kit is expressed in approximately 80% of AML cases. The kinase domain mutation of the c-kit gene, one of the most common gain-of-function mutations associated with t(8;21) AML, predicts higher relapse risk and poor prognosis. However, the role of c-kit high expression in t(8;21) AML remains poorly understood. Here we evaluated the prognostic significance of c-kit expression levels in AML patients. The mRNA expression of c-kit was determined by real-time quantitative reverse transcription PCR in 132 adult AML patients. Patients were grouped into quartiles according to c-kit expression levels (Q1-Q4, each quartile containing 25% of patients) and divided into c-kit high (Q4; n = 33) and c-kit low (Q1-Q3; n = 99). High c-kit expression was associated with AML1/ETO-positive and with c-kit mutation. Of note, 35.8% of the AML1/ETO-positive AML patients carrying wild-type c-kit expressed high levels of c-kit, suggesting that other factors are involved in c-kit overexpression. High c-kit expression was associated with inferior overall and event-free survival in AML1/ETO-positive patients and was independently predictive for overall and event-free survival in multivariate analyses in a c-kit mutation-independent manner. Thus, high c-kit expression serves as a reliable molecular marker for poor prognosis, supporting a pathogenetic role of c-kit signaling in AML1/ETO-positive AML. AML1/ETO-positive patients with high c-kit expression might benefit from early treatment modifications and molecular target therapies.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Chromosomes, Human, Pair 21 / genetics
  • Chromosomes, Human, Pair 8 / genetics
  • Cohort Studies
  • Core Binding Factor Alpha 2 Subunit / genetics*
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Leukemia, Myeloid, Acute / genetics*
  • Leukemia, Myeloid, Acute / mortality
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Oncogene Proteins, Fusion / genetics*
  • Prognosis
  • Proto-Oncogene Mas
  • Proto-Oncogene Proteins c-kit / genetics*
  • RNA, Messenger / genetics
  • RNA, Neoplasm / genetics
  • RUNX1 Translocation Partner 1 Protein
  • Translocation, Genetic
  • Up-Regulation
  • Young Adult

Substances

  • AML1-ETO fusion protein, human
  • Core Binding Factor Alpha 2 Subunit
  • MAS1 protein, human
  • Oncogene Proteins, Fusion
  • Proto-Oncogene Mas
  • RNA, Messenger
  • RNA, Neoplasm
  • RUNX1 Translocation Partner 1 Protein
  • Proto-Oncogene Proteins c-kit

Grants and funding

This work was partially supported by grants from the National Natural Science Foundation of China (81170518 to LY; 81000221 and 81370010 to XNG; 81171820 to JL and 81370635 to YHL), the National Public Health Grand Research Foundation (201202017 to LY), the Capital Public Health Project (Z111107067311070 to LY), and the Beijing Natural Science Foundation (7122169 to XNG and 7112126 to JL). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.