High expression of HMGA2 independently predicts poor clinical outcomes in acute myeloid leukemia.
Miriam MarquisCyrielle BeauboisVincent-Philippe LavalléeMichal AbrahamowiczCoraline DanieliSébastien LemieuxImran AhmadAndrew WeiStephen B TingShaun FlemingAnthony SchwarerDavid GrimwadeWilliam GreyRobert K HillsParesh VyasNigel RussellGuy SauvageauJosée HébertPublished in: Blood cancer journal (2018)
In acute myeloid leukemia (AML), risk stratification based on cytogenetics and mutation profiling is essential but remains insufficient to select the optimal therapy. Accurate biomarkers are needed to improve prognostic assessment. We analyzed RNA sequencing and survival data of 430 AML patients and identified HMGA2 as a novel prognostic marker. We validated a quantitative PCR test to study the association of HMGA2 expression with clinical outcomes in 358 AML samples. In this training cohort, HMGA2 was highly expressed in 22.3% of AML, mostly in patients with intermediate or adverse cytogenetics. High expression levels of HMGA2 (H + ) were associated with a lower frequency of complete remission (58.8% vs 83.4%, P < 0.001), worse 3-year overall survival (OS, 13.2% vs 43.5%, P < 0.001) and relapse-free survival (RFS, 10.8% vs 44.2%, P < 0.001). A positive HMGA2 test also identified a subgroup of patients unresponsive to standard treatments. Multivariable analyses showed that H + was independently associated with significantly worse OS and RFS, including in the intermediate cytogenetic risk category. These associations were confirmed in a validation cohort of 260 patient samples from the UK NCRI AML17 trial. The HMGA2 test could be implemented in clinical trials developing novel therapeutic strategies for high-risk AML.
Keyphrases
- acute myeloid leukemia
- free survival
- clinical trial
- poor prognosis
- end stage renal disease
- ejection fraction
- newly diagnosed
- allogeneic hematopoietic stem cell transplantation
- prognostic factors
- single cell
- emergency department
- stem cells
- randomized controlled trial
- machine learning
- electronic health record
- rheumatoid arthritis
- mass spectrometry
- patient reported
- acute lymphoblastic leukemia
- mesenchymal stem cells
- cell therapy
- disease activity
- bone marrow
- smoking cessation
- adverse drug
- placebo controlled