High expression of ETS2 predicts poor prognosis in acute myeloid leukemia and may guide treatment decisions

Background: ETS2 is a downstream effector of the RAS/RAF/ERK pathway, which plays a critical role in the development of malignant tumor. However, the clinical impact of ETS2 expression in AML remains unknown. Methods: In this study, we evaluated the prognostic significance of ETS2 expression using two relatively large cohorts of AML patients. Results: In the first cohort, compared to low expression of ETS2 (ETS2(low)), high expression of ETS2 (ETS2(high)) showed significant shorter OS, EFS and RFS in the current treatments including the allogeneic HCT group (n = 72) and the chemotherapy group (n = 100). Notably, among ETS2(high) patients, those received allogeneic HCT had longer OS, EFS and RFS than those with chemotherapy alone (allogeneic HCT, n = 39 vs. chemotherapy, n = 47), but treatment modules play insignificant role in the survival of ETS2low patients (allogeneic HCT, n = 33 vs. chemotherapy, n = 53). Moreover, gene/microRNA expression data provides insights into the biological changes associated with varying ETS2 expression levels in AML. The prognostic value of ETS2 was further validated in the second AML cohort (n = 329). Conclusions: Our results indicate that ETS2high is a poor prognostic factor in AML and may guide treatment decisions towards allogeneic HCT.