OVEREXPRESSION OF LYMPHOID ENHANCER BINDING FACTOR-1 (LEF1) PREDICTS FAVORABLE OUTCOME IN CYTOGENETICALLY NORMAL ACUTE MYELOID LEUKEMIA (CN-AML).

Background:- Lymphoid enhancer-binding factor 1 (LEF1) is a downstream effector of the Wnt/β-catenin signaling pathway, which controls cell growth and differentiation. Dysregulation of LEF1 expression may result in several disease patterns and hematological malignancies, as the Wnt signaling plays a pivotal role in development and cancerogenesis. Patients and methods:- We investigated the influence of LEF1 expression in 72 adults with cytogenetically normal acute myeloid leukemia (CN-AML) patients together with 30 healthy controls using a Real-Time Quantitative Reverse-Transcriptase Polymerase Chain Reaction (RTQ-PCR) to assess the possible relation, association or correlation between LEF1 expression and CN-AML clinical and laboratory features at diagnosis and follow up. Results:- We found that both the expression rate and expression level of LEF-1 gene were significantly higher in AML patients than in controls (p=˂0.001). LEF-1 high expressors had significantly lower WBCs and BM blasts compared to LEF-1 Low expressors, the difference was statistically significant (p=0.03, 0.02) respectively. Hepatosplenomegaly was more encountered in LEF-1 Low expressors compared to LEF-1 high expressors (p=0.05). LEF-1 high expressors were associated with favorable treatment outcomes as they were associated with significantly better overall survival (p=0.001), disease-free survival ( p=0.04), and event-free survival ( p=0.008). Complete remission (CR) were more achieved in LEF-1 high expressors than LEF-1 Low expressors; yet the difference was not statistically significant (p=0.1). Conclusion:- Our study has shown that LEF1 is a favorable prognostic factor in CN-AML. It could therefore be useful to improve risk stratification and to develop better treatment strategies and suggest the need of alternative regimens.