[Prognostic Value of Dynamic Monitoring of WT1 Expression Levels for Relapse and Overall Survival in AML Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation During First Complete Remission].

OBJECTIVE

To analyze the predictive role of WT1 expression levels pre- and early post-transplantation on relapse and overall survival (OS) in patients with acute myeloid leukemia (AML) undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) during their first complete remission (CR1).

METHODS

A retrospective analysis was conducted on the clinical data of 107 adult AML patients who underwent allo-HSCT during their CR1 at our center between May 2012 and December 2021. The predictive role of bone marrow WT1 expression levels before transplantation and at 3 and 6 months post-transplantation on relapse and OS was explored in combination with relevant clinical factors.

RESULTS

The median follow-up time for the 107 patients was 70 (range: 11-117) months. Among the patients, 15 cases died. Kaplan-Meier survial analysis showed that the 3-year overall survival (OS) rate was 85.0%. 20 patients experienced relapse, with a median time to relapse of 8 (range: 0.5-44) months and a 1-year cumulative relapse rate of 13.1%. The overall median value of WT1 before transplantation, 3 months after transplantation, and 6 months after transplantation was 0.26% (range: 0%-23.64%), with an upper quartile value of 0.74%. No statistically significant differences in WT1 expression levels were observed among the pre-transplantation, 3-month post-transplantation, and 6-month post-transplantation time points (P =0.227). Univariate analysis showed that patients with WT1 levels >0.74% at 3 months post-transplantation had a higher 1-year relapse rate (P =0.029) and lower 3-year OS rate (P <0.001) compared to patients with WT1 levels ≤0.74%. Other significant factors affecting 1-year relapse included stem cell source (P =0.041) and chronic graft-versus-host disease (cGVHD) (P =0.013). For 3-year OS, additional influencing factors were genetic high risk (P =0.048) and stem cell source (P =0.016). Multivariate analysis revealed that WT1 level >0.74% at 3 months post-transplantation had a trend to affect 1-year relapse rate (HR=3.309, 95%CI : 0.958-11.431, P =0.058), while the absence of cGVHD was an independent risk factor for 1-year relapse (HR=3.473, 95%CI : 0.749-16.100, P =0.037). Only WT1 level >0.74% at 3 months post-transplantation was an independent risk factor for 3-year OS (HR=6.886, 95%CI : 2.402-19.738, P <0.001).

CONCLUSION

High WT1 expression level at 3 months post-transplantation in AML patients undergoing allo-HSCT during CR1 affects the 1-year relapse rate and 3-year OS, and is an independent risk factor affecting 3-year OS. These findings suggest that dynamic monitoring of WT1 expression levels has certain value in prognostic assessment of AML patients who received allo-HSCT during CR1.