Molecular Characterization and Risk Stratification of Acute Myeloid Leukemia

最近的分子分析显示，在诊断时，就存在显著的异质性 获得性的、预后的染色体异常、基因突变和基因表达的变化 急性髓系白血病(AML)患者。基因和microRNA表达谱的应用 还识别了似乎在特定细胞遗传学亚群中对AML患者进行分层的表达特征 分成预后亚组。这些和类似的未来发现可能会对临床产生重大影响 急性髓系白血病的管理，不仅是为了预测过程，也是为了选择合适的 治疗，因为许多已确定的基因改变构成或将可能成为 特定的治疗干预。以癌症和白血病B组(CALGB)为平台 治疗研究，我们建议在这里进行权威性分析，评估频率和 分子异常在大量AML患者中的预后价值。此外，我们将整合 从预后细胞遗传学异常和基因突变的分析中获得的信息 从相应的全基因组基因和microRNA表达谱中获得 对白血病发生机制的生物学洞察，并确定分层的“综合功能标志” 将患者分成具有特定治疗方案的“有针对性”的子组。我们将通过以下方式实现这些目标 三个具体目标：1.确定分子像差的频率(例如，Flt3 ITD，MLL PTD， NPM1、WT-1、CEBPA、RAS、KIT突变和BAALC异常。ERG、Flt3、MNI和EVI1 Over- 诊断时)，并将其与临床和实验室特征及预后相关联 接受CALGB治疗方案的年轻和老年AML患者的不同细胞遗传学亚群； 2.在诊断时识别特定的全基因组基因表达特征，并将它们与 不同细胞遗传学和分子亚群的临床和实验室特征及转归 参加CALGB治疗方案的年轻和老年AML患者；3.鉴定特定基因组 诊断时广泛的microRNA表达特征及其与临床和实验室的相关性 年轻和老年AML不同细胞遗传学和分子亚群的特征和转归 参加CALGB治疗方案的患者。我们预计这项研究计划的完成将 允许对急性髓细胞白血病患者进行风险适应的分层治疗，使之成为针对特定目标的“个性化”治疗方案 异常的“功能性”造血基因特征，是急性髓系白血病不同亚型的特征。 相关性(请参阅说明)： 急性髓系白血病(AML)是最常见的白血病类型之一，以成熟为特征 阻止和增殖骨髓和血液中的恶性细胞。尽管最近取得了进展，但大多数患者 死于他们的疾病。因此，迫切需要新的方法来改善这些患者的预后。 在这里，我们建议对急性髓细胞白血病患者的恶性细胞进行表征，找出可以预测的基因缺陷。 结果。这种方法最终将允许识别AML的亚群，这些亚群将对特定的和 “个人化”治疗，从而改善这些患者目前糟糕的临床结果。

Recent molecular analyses have revealed at diagnosis, a striking heterogeneity with regard to the presence of acquired, prognostic chromosome aberrations, gene mutations and changes in gene expression in patients with acute myeloid leukemia (AML). Application of gene and microRNA-expression profiling has also identified expression signatures that appear to stratify AML patients within specific cytogenetic subsets into prognostic subgroups. These and similar future findings are likely to have a major impact on the clinical management of AML, not only for the prognostication process but also for the selection of appropriate treatments, since many of the identified genetic alterations constitute or will potentially become targets for specific therapeutic intervention. Using as a platform the Cancer and Leukemia Group B (CALGB) upfront treatment studies, we propose here to conduct definitive analyses that assess the frequencies and prognostic values of molecular abnormalities in a large population of AML patients. Further, we will integrate the information derived from the analysis of prognostic cytogenetic aberrations and gene mutations with that derived from the corresponding genome wide gene and microRNA expression profiles in order to gain biologic insights into leukemogenic mechanisms and identify "integrated functional signatures" that stratify patients into subsets "targetable" with specific therapeutic programs. We will achieve these goals through three Specific Aims: 1. To determine the frequency of molecular aberrations {e.g., FLT3 ITD, MLL PTD, NPM1, WT-1, CEBPA, RAS, KIT mutations and aberrant BAALC. ERG, FLT3, MNI and EVI1 over- expression) at diagnosis and to correlate them with clinical and laboratory characteristics and outcome in distinct cytogenetic subgroups of younger and older AML patients enrolled on CALGB treatment protocols; 2. To identify specific genome wide gene expression signatures at diagnosis and to correlate them with clinical and laboratory characteristics and outcome in distinct cytogenetic and molecular subgroups of younger and older AML patients enrolled on CALGB treatment protocols; 3. To identify specific genome wide microRNA expression signatures at diagnosis and to correlate them with clinical and laboratory characteristics and outcome in distinct cytogenetic and molecular subgroups of younger and older AML patients enrolled on CALGB treatment protocols. We anticipate that completion of this research plan will allow risk-adapted stratification of AML patients into "personalized" treatment protocols designed to target the aberrant "functional" hematopoietic gene signatures that characterize distinct subsets of AML. RELEVANCE (See instructions): Acute myeloid leukemia (AML) is one ofthe most common types of leukemia and is characterized by maturation arrest and proliferation of malignant cells in bone marrow and blood. Despite recent progress, most of patients die of their disease. Therefore, novel approaches that improve the outcome of these patients are highly needed. Here, we propose to characterize malignant cells from AML patients for genetic defects that can predict outcome. This approach will ultimately allow identification of subgroups of AML that will respond to specific and "personalized" treatments thereby improving the currently poor clinical outcome of these patients.