SALL4 Oncogene in Acute Myeloid Leukemia: Expression Levels and Prognostic Impact

Abstract

Background: SALL4, a zinc finger transcription factor, is an embryonic stem cell regulator that controls self-renewal and pluripotency.  Recently, SALL4 overexpression has been observed in malignant tumors such as lung cancer and hepatocellular carcinoma.

Objective:  We aimed at evaluating the expression pattern of the SALL4 gene in individuals with acute myeloid leukaemia (AML) and determine its  prognostic impact.

Patients and Methods: This study was a prospective, single center study conducted on 35 adult Egyptian patients  with AML, recruited from the Hematology Unit of the Internal Medicine Department at Ain Shams University Hospitals during the period  from January 2021 to April 2021 whose ages ranged between 18 and 73 years old. Real-time quantitative PCR (RT-PCR) was used to assess the expression level of SALL4 mRNA in bone marrow (BM) mononuclear cells from 35 AML patients, and 15 patients who were candidates  for BM aspiration for causes other than hematological or solid malignancies as controls.

Results: The expression of SALL4 was  significantly higher in cases of acute myeloid leukemia compared to controls (p value= 0.001). Strong association was also found between  SALL4 expression levels and failure to achieve complete remission (CR) revealed by post-induction BM blast percentage and  minimal residual disease (MRD) detection by immunophenotyping (r values of 0.68 and 0.62, respectively, p values= 0.001 in both cases).  

Conclusion: SALL4 is significant prognostic factor in de-novo AML and could be strong target for novel types of therapy.