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Significant Correlation Between the Degree of WT1 Expression and the International Prognostic Scoring System Score in Patients With Myelodysplastic Syndromes

Daniela Cilloni, Enrico Gottardi, Francesca Messa, Milena Fava, Patrizia Scaravaglio, Marilena Bertini, Mauro Girotto, Carlo Marinone, Dario Ferrero, Andrea Gallamini, Alessandro Levis, Giuseppe Saglio for the Piedmont Study Group on Myelodysplastic Syndromes

From the Division of Hematology and Internal Medicine, Department of Clinical and Biological Sciences of the University of Turin; Divisions of Hematology and Internal Medicine, S. Giovanni Battista Hospital, Turin; Immunohematology Service, Ivrea; Division of Hematology, S. Croce Hospital, Cuneo; and Division of Hematology, SS. Antonio e Biagio Hospital, Alessandria, Italy.

Address reprint requests to Giuseppe Saglio, MD, Department of Clinical and Biological Sciences of the University of Turin, San Luigi Hospital, Gonzole 10, 10043 Orbassano-Torino, Italy; email: saglio{at}csi.it.

Purpose: To determine whether pattern of WT1 gene expression is a useful marker for establishing prognosis and tracking disease progression in patients with myelodysplastic syndromes (MDS).

Patients and Methods: We performed a quantitative assessment of the WT1 transcript amount by real-time quantitative polymerase chain reaction (RQ-PCR) in 173 samples (131 bone marrow samples and 42 peripheral-blood samples) from 131 patients with MDS (79 patients with refractory anemia [RA], 31 with RA with excess blasts [RAEB], 18 with secondary acute myeloid leukemia [s-AML] evolved from MDS, and three with deletion of 5q as the sole cytogenetic abnormality). Values obtained were correlated with the blast percentage and International Prognostic Scoring System (IPSS) score.

Results: Sixty-five percent of BM and 78% of PB samples for RA and 100% of BM and PB samples of RAEB and s-AML expressed WT1 transcript amounts greater than the level observed in healthy volunteers. The degree of WT1 expression was highly correlated with the type of MDS, was much higher in RAEB and s-AML compared with RA, and increased during disease progression. Moreover, a significant correlation was found between WT1 expression levels, blast cell percentage, and the presence of cytogenetic abnormalities. Therefore, we found a significant correlation between the amount of WT1 transcripts and the IPSS score, which currently represents the most reliable risk index of disease progression available for MDS patients.

Conclusion: WT1 is a useful molecular marker for risk assessment in MDS patients.

Supported by grants from Associazione Italiana per la Ricerca sul Cancro, Ministero Universita Ricerca Scientifica Tecnologica Cofinanzianento 2002, and Associazione Italiana contro le Leucemie.

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