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In childhood acute lymphoblastic leukemia (ALL), early response to treatment is a powerful prognostic indicator. To identify genes associated with this response, we analyzed gene expression of diagnostic lymphoblast from 189 children with ALL and compared the findings with minimal residual disease (MRD) levels on days19 and 46 of remission induction treatment. After excluding genes associated with genetic subgroups, we identified 17 genes that were significantly associated with MRD. The caspase 8–associated protein 2 (CASP8AP2) gene was studied further because of its reported role in apoptosis and glucocorticoid signaling. In a separate cohort of 99 patients not included in the comparison of gene expression profiles and MRD, low levels of CASP8AP2 expression predicted a lower event-free survival and a higher rate of leukemia relapse and were an independent predictor of outcome. High levels of CASP8AP2 expression were associated with a greater propensity of leukemic lymphoblast to undergo apoptosis. We conclude that measurement of CASP8AP2 expression at diagnosis offers a means to identify patients whose leukemic cells are highly susceptible to chemotherapy. Therefore, this gene is a strong candidate for inclusion in gene expression arrays specifically designed for leukemia diagnosis.
This article appears in Blood 2006. Other authors include Christian Flotho (St. Jude-Pathology), Elaine Coustan-Smith (St. Jude-Oncology), Deqing Pei (St. Jude-Biostatistics), Shotaro Iwamoto (St. Jude- Hematology-Oncology), Guangchun Song (St. Jude-Pathology), Ching-Hon Pui (St. Jude-Oncology), James R. Downing (St. Jude-Pathology), and Dario Campana (St. Jude-Oncology).