Study of transcription factor CCAAT/enhancer binding protein-alpha (C/EBP alpha) in adult patients with acute lymphoblastic leukemia

Background Leukemic stem cells have self-renewal property. Identification of genes or signaling pathways involved in self-renewal of leukemic stem cells will promote the development of more effective treatment for acute leukemias. Objectives To assess the prognostic significance of the CCAATT/enhancer binding protein-alpha (C/EBP alpha) transcription factor in primary adult patients with acute lymphoblastic leukemia (ALL) and its correlation to prognosis and response to therapy. Participants and methods Forty adult patients with ALL (23 pre-B ALL, one pro-B ALL, four mature B ALL, and 12 T ALL) were recruited from the Hematology Department, Ain Shams University, compared with 25 age-matched and sex-matched healthy controls. All patients were subjected to a complete blood count, blood chemistry, bone marrow (BM) examination, immunophenotyping, cytogenetics, and assessment of the C/EBP alpha level using real-time PCR at presentation and at D28 of treatment. Patients were followed over a period of 24 months (1-24 ms). Results Compared with controls, patients with ALL at presentation and at follow-up showed a highly significant difference in C/EBP alpha (P < 0.01), whereas there was no significant difference between B ALL and T ALL. Patients who achieved remission showed a significant increase in C/EBP alpha after treatment. There was no significant correlation between C/EPB alpha and other prognostic factors in ALL, except with the Philadelphia chromosome; there was a significantly negative correlation at diagnosis and at follow-up. Conclusion Deficient C/EBP alpha among patients with ALL may contribute toward its pathogenesis and remission is associated with a significant increase in the C/EBP alpha level. C/EBP alpha is an independent prognostic factor and its measurement helps to predict response and contributes significantly toward better management decisions. (C) 2012 The Egyptian Society of Haematology.