Clinical impact of expression in high-risk acute promyelocytic leukemia.

Although overexpression of the brain and acute leukemia, cytoplasmic () gene is associated with primary resistant disease and shorter relapse-free, disease-free, and overall survival in different subsets of acute myeloid leukemia (AML), little is known about its clinical impact in acute promyelocytic leukemia (APL). Using real-time reverse transcriptase polymerase chain reaction, we showed that expression is significantly lower in APL compared with other subsets of AML ( < .001). We also demonstrated that overexpression was associated with shorter disease-free survival (DFS) (hazard ratio [HR], 4.43; 95% confidence interval [CI], 1.29-15.2; = .018) in 221 consecutive patients (median age, 35 years; range, 18-82 years) with newly diagnosed APL homogeneously treated with all- retinoic acid and anthracycline-based chemotherapy. Cox proportional hazard modeling showed that overexpression was independently associated with shorter DFS in the total cohort (HR, 5.26; 95% CI, 1.52-18.2; = .009) and in patients with high-risk disease (ie, those with initial leukocyte counts >10 × 10/L) (HR, 5.3; 95% CI, 1.14-24.5; = .033). We conclude that expression could be useful for refining risk stratification in APL, although this needs to be confirmed in independent cohorts.