Clinical Characteristics, Efficacy And Prognostic Factors Of WT1 Gene (+) Adult Acute Lymphoblastic Leukemia

Objective:To analyze clinical features,efficacy and prognostic factors of adult acute lymphoblastic leukemia with the Wilms tumor 1(WT1)gene.Methods:109 newly diagnosed adult acute lymphoblastic leukemia patients with the Wilms tumor 1(WT1)gene from June,2015 to December,2018 were enrolled Retrospectively analyzed their clinical features,efficacy and prognostic factors.Results:The incidence frequency of WT1 gene in adult acute lymphoblastic leukemia was 64.1%(109/170),including 68 males and 41 females.The median age was 30 years old ranged from 14 to 64 years.The median value of leucocyte,hemoglobin and platelet at diagnosis was 22.1(range,0.59-437.2)× 109/L、97(range,39-161)g/L and 52(range,5-478)×109/L,respectively.B-cell phenotype accounts for 80.73%(88/109)of all the cases,most of which being present in common-B-ALL,while T-ALL accounts for the rest 19.27%.The median relative expression value of WT1 gene at diagnosis was 17.86%(range,2.06%-973.21%),which was no significantly related to age,gender,immune phenotype or platelet value at diagnosis.Patients with MLL rearrangement and higher leucocyte(≥ 50 ×109/L)at diagnosis had significantly higher WT1 gene expression,while patients with BCR-ABL fusion expressed significantly lower WT1 gene value.The follow up period ended in June 2020 with a median follow up time of 23(range,1-60)months.The estimated 4-year-OS and 4-year-DFS was 59.8%±5.3%,52.0%±8.4%,respectively,which showed no obvious differences with WT1 gene negative group.Cox regression multivariate analysis revealed that poor prognostic factors influencing survival included MRD positivity after induction chemotherapy(P=0.03)and MLL rearrangement(P=0.014)only.Conclusion:WT1 gene was relative common at diagnosis in adult acute lymphoblastic leukemia.Patients with MLL rearrangement and higher leucocyte[≥50×109/L)at diagnosis had significantly higher WT1 gene expression,while patients with BCR-ABL fusion expressed significantly lower WT1 gene value.Positive MRD after induction chemotherapy and accompanying with MLL rearrangement were unfavourable prognostic factors for survival.