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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
11

Klinički i prognostički značaj ekspresije gena EVI1 u akutnoj mijeloidnoj leukemiji / Clinical and Prognostic Significance of EVI1 Expression in Acute Myeloid Leukaemia

Sekulić Borivoj 11 December 2015 (has links)
<p>UVOD: Akutna mijeloidna leukemija (AML) predstavlja heterogenu grupu oboljenja u odnosu na morfologiju, citogenetiku, molekularnu genetiku, zbog čega se deli na različite kliničke i biolo&scaron;ke entitete, sa različitim odgovorom na terapiju i ishodom lečenja. Humani EVI1 (ecotropic virus integration-1) gen ima ulogu multifunkcionalnog nuklearnog transkripcionog faktora, kako u normalnoj tako i u malignoj hematopoezi. Sve je vi&scaron;e istraživanja koja ističu negativni prognostički značaj visoke ekspresije (overexpression) EVI1 gena u AML.&nbsp; CILJEVI: Ciljevi ovog istraživanja su da se ispita klinički i prognostički značaj ekspresije gena EVI1 u AML, kao i da se utvrdi povezanost visoke ekspresije gena EVI1 sa nalazima citogenetskog ispitivanja i molekularnim markerima: FLT3 mutacijom i nukleofozmin 1 (NPM1) mutacijom. MATERIJAL I METODE: Ovim prospektivnim istraživanjem je obuhvaćena grupa od 38 odraslih novodijagnostikovanih bolesnika sa de novo, non M3 AML, kod kojih je započeto standardno lečenje, a koji su dijagnostikovani i lečeni u Klinici za hematologiju Kliničkog centra Vojvodine u periodu od jula 2012. do marta 2014. Određivanje ekspresije gena EVI1 je vr&scaron;eno pomoću real time kvantitativne PCR (qPCR) metode, tehnikom TaqMan, a relativna ekspresija EVI1 gena je određena primenom &Delta;&Delta;Ct metode.&nbsp; REZULTATI: Medijana starosti bolesnika pri postavljanju dijagnoze AML je bila 52 godine (23-80). Ustanovljena je statistički značajna razlika između ekspresije gena EVI1 kod zdravih osoba (kontrolna grupa) i obolelih od akutne mijeloidne leukemije (p=0.008). Računajući relativnu ekspresiju, 13,2 % bolesnika je imalo visoku ekspresiju (overexpression) gena EVI1. U odnosu na kliničke i laboratorijske karakteristike bolesnika (kao &scaron;to su pol, starost, parametri krvne slike, nivo laktat dehidrogenaze, procenat blasta u perifernoj krvi i ko&scaron;tanoj srži, potom tip akutne mijeloidne leukemije, performans status, komorbiditetni indeks) nije ustanovljena statistički značajna razlika između bolesnika sa visokom ekspresijom EVI1 gena i ostalih bolesnika. Postoji statistički značajna povezanost visoke ekspresije EVI1 gena i nepostojanja NPM1 mutacije (p=0,031), kao i između visoke ekspresije EVI1 gena i prisustva monozomije 7 (p=0,047). Visoka ekspresija EVI1 gena je povezana sa kraćim preživaljvanjem bez dogaĎaja (p=0,004), kao i sa kraćim ukupnim preživljavanjem (p=0,025).&nbsp; ZAKLJUČCI: Postoji značajno povećana ekspresija gena EVI1 kod obolelih od AML u odnosu na zdrave kontrole. Visoka ekspresija EVI1 gena je faktor lo&scaron;e prognoze kod obolelih od akutne mijeloidne leukemije i u kombinaciji sa drugim prognostičkim markerima, doprinosi boljoj risk stratifikaciji ovih bolesnika.</p> / <p>INTRODUCTION: Acute myeloid leukaemia (AML) represents a heterogenous group of diseases in terms of morphology, cytogenetics, molecular genetics, so it can be divided into distinct clinical and biological entities, with variable responsiveness to therapy and different treatment outcome. Human EVI1 (ecotropic virus integration-1) gene plays a role of multifunctional nuclear transcriptional factor, not only in normal, but also in malignant haematopoiesis. There are more and more investigations indicating high EVI1 expression (EVI1 overexpression) as a negative prognostic marker in AML.&nbsp; PURPOSES: The main goal of this investigation was to examine the clinical and prognostic significance of EVI1 expression in AML, as well as to investigate whether there was any association of EVI1 overexpression with cytogenetic abnormalities and other standard molecular prognostic factors, such as FLT3 mutation and nucleophosmin 1 (NPM1) mutation.&nbsp; PATIENTS AND METHODS: This prospective study included 38 adult newly diagnosed patients with de novo nonM3 AML, in whom a standard treatment was started at Clinic of Haematology, Clinical center of Vojvodina in the period from July 2012 to March 2014. EVI1 expression was analyzed by real-time quantitative polymerase chain reaction using TaqMan, and relative EVI1 expression was determined by &Delta;&Delta;Ct method.&nbsp; RESULTS: Median age of patients at diagnosis was 52 (aged 23-80). There has been determined statistically higher EVI1 expression in our AML patients than in healthy volunteers (control group) (p=0.008). The relative EVI1 overexpression was observed in 13.2% of the patients. No significant differences in clinical and laboratory patient data (including sex, age, whole blood counts, lactate dehydrogenase level, peripheral and bone marrow blast percentages, type of AML, performance status, comorbidity index) were observed between patients with high EVI1 expression and patients without high EVI1 expression. Our investigation revealed inverse correlation of high EVI1 expression and nucleophosmin 1 mutation (p=0,031). Also high EVI1 expression was significantly associated with monosomy 7 (p=0,047). Survival analysis revealed significantly inferior event free survival (p=0,004) and overall survival (p=0,025) for patients with high EVI1 expression compared to the other patients.&nbsp; CONCLUSION: EVI1 expression is significantly higher in AML patients compared to healthy controls. High EVI1 expression is a poor prognostic marker for patients with AML, and in combination with other well established prognostic markers, contributes to better risk stratification of these patients.</p>

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