Lymphoid enhancer factor 1 gene expression in comparison to other prognostic markers in adult B-acute lymphoblastic leukemia

Background Activation of the canonical Wnt signaling pathway by the key mediator lymphoid enhancer factor 1 (LEF1) plays an important role in the development of several hematological and nonhematological malignancies. Aims The aim was to study LEF1 gene expression in adult B-acute lymphoblastic leukemia (ALL) and its clinical significance in comparison to other prognostic markers to improve risk-adapted treatment stratification for high-risk patients. Patients and methods The study was conducted on 50 adult cases with newly diagnosed B-ALL and 50 adult healthy controls with matched age and sex. The cases were divided into three groups according to risk assessment: low risk (have no risk factor), intermediate risk group (have one or more risk factors), and high risk (BCR-ABL positive). LEF1 gene expression was analyzed using quantitative real-time PCR and its correlation with clinical characteristics and treatment outcome at day 28 after induction chemotherapy and in 6 months follow-up period was assessed. Results LEF1 gene expression showed statistically significant higher expression in ALL cases compared with control (P=0.001). Higher LEF1 gene expression was detected in the high-risk group compared with comparable gene expression in both low- and intermediate- risk groups (P=0.05). Statistically significant positive correlation was detected between LEF1 gene expression and BCR-ABL positive cases. Statistically significant positive correlation was detected between the non-remission group and high LEF1 gene expression (Z=3.026, P=0.002). Conclusion The high LEF1 gene expression at diagnosis may be used in identifying patients with high risk of treatment failure. The high LEF1 gene expression can be a prognostic marker in adult B-ALL patients.