急性T淋巴细胞白血病移植后WT1基因表达与预后关系

Background: To evaluate the significance of Wilms tumor-1(WT1) gene expression level on monitoring minimal residual disease (MRD) and predicting prognosis in patients of acute T lymphoblastic leukemia(T-ALL) following allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods: This retrospective study analysis 68 T-ALL cases from January 2009 to March 2012, that monitoring WT1gene expression levelafter allo-HSCT.WT1 expression level was measured with real-time quantitative reverse transcription polymerase chain reaction (RQ-PCR) method at+30, +60, +90, +180, +270, +360 daysafter allo-HSCT, simultaneouslyusing flow cytometry(FCM)monitoring residualleukemia. Results: WT1 geneexpression low levelassociate with a lowrisk of recurrence afterallo-HSCT in T-ALL. IncreasedWT1 geneexpression level at +60and +90days after allo-HSCT associatedwithhighercumulativerecurrence rate(P<0.001, P<0.003),andlowthedisease-free survival(P=0.004, P=0.006), and overallsurvival rate(P=0.004, P<0.007). The presence ofMRDafter transplantationisan independent prognostic factorin relapsein T-ALL.Combining WT1geneand FCMcan be used to monitorrecurrenceafter allo-HSCT. Conclusions:IncreasedWT1 geneexpression level at +60and +90days after allo-HSCT significantly associatedwithworse prognosis, that should be intervenedas early as possibleto reducethe riskof recurrenceor death. WT1 geneexpression level that is less than0.6% is associated withlowerrisk of recurrence. WT1 gene expressionmore than 0.6% that needs close follow-up, combined with FCMmonitoringMRD, which requiredto achieve intervention to reduce the relapse rate.