Characteristics and clinical significances of LDHA expression in pediatric acute myeloid leukemia
10.3760/cma.j.cn115356-20250125-00012
- VernacularTitle:急性髓系白血病患儿骨髓LDHA表达特点及临床意义
- Author:
Meiye WANG
1
;
Ping MA
;
Baohong YUE
Author Information
1. 郑州大学附属儿童医院 河南省儿童医院 郑州儿童医院 河南省儿童遗传代谢性疾病重点实验室，郑州 450018
- Keywords:
Leukemia, myeloid, acute;
Child;
Lactate dehydrogenases;
Prognosis
- From:
Journal of Leukemia & Lymphoma
2025;34(7):397-402
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the characteristics of lactate dehydrogenase A (LDHA) gene expression in bone marrow mononuclear cells of children with acute myeloid leukemia (AML), and its association with clinical efficacy and prognosis, and the clinical significances.Methods:A retrospective case series study was conducted. Forty newly-treated AML (non-acute promyelocytic leukemia) children confirmed by morphology, immunology, cytogenetics, and molecular biology at the Children's Hospital Affiliated to Zhengzhou University from February 2021 to March 2022 were included in the AML group, and the pediatric patients were given induction therapy, consolidation therapy and maintenance therapy according to the Chinese Children's Leukemia Group AML-2019 protocol. Eighteen children undergoing bone marrow examination for non-hematologic diseases (iron-deficiency anemia, idiopathic thrombocytopenic purpura, etc.) during the same period served as the control group. Real-time quantitative polymerase chain reaction (qRT-PCR) was used to detect LDHA mRNA expression levels in bone marrow mononuclear cells before treatment. Patients were categorized into high and low LDHA expression groups based on the median relative expression of LDHA mRNA. LDHA mRNA levels were compared between the AML and control groups, as well as among AML patients with different treatment responses. The distribution of LDHA high or low expression patients was analyzed across clinical characteristic subgroups. Kaplan-Meier method was used for overall survival analysis of children with high and low expression of LDHA, and log-rank test was used for inter group comparison.Results:There were 26 males (65.0%) and 14 females (35.0%) in the AML group, with an age of (4.9±3.3) years; there were 9 males (50.0%) and 9 females (50.0%) in the control group, with an age of (4.2±2.8) years; there was no statistically significant difference in age and gender between the two groups (both P > 0.05). The relative expression level of LDHA mRNA before treatment in bone marrow mononuclear cells of AML patients was higher than that of the control group (4.32±1.21 vs. 1.05±0.38), and the relative expression level of LDHA mRNA before treatment in AML patients who did not improve after induction therapy (8 cases) was higher than that in AML patients who achieved complete remission (CR) after induction therapy (32 cases) (5.89±1.45 vs. 3.76±1.02), and the differences were statistically significant (both P < 0.05). The median relative expression level of LDHA mRNA in AML patients was 2.90, and 20 patients with high LDHA expression and 20 patients with low LDHA expression were classified according to this value. The proportion of AML patients with LDHA high expression in the CR after induction therapy group was lower than that in the NR group [37.5% (12/32) vs. 8/8], and the difference was statistically significant ( P = 0.003). However, there was no statistically significant difference in the proportion of patients with high LDHA expression among the subgroups of gender, age ≥ 10 years, France-America-Britain classification, white blood cell count ≥ 50×10 9, and risk stratification (all P > 0.05). Forty AML children were followed up for a median of 23 months (ranging from 6 to 36 months); 9 cases (22.5%) died, including 2 cases with LDHA low expression and 7 cases with LDHA high expression, accounting for 10.0% and 35.0% of the two groups, respectively. Kaplan-Meier survival analysis showed that the overall survival of the LDHA low expression group was better than that of the LDHA high expression group, and the difference was statistically significant ( P = 0.036). Conclusions:LDHA is highly expressed in bone marrow mononuclear cells of children with AML, and its expression level may be related to the efficacy and overall survival, which may be a potential biomarker for prognostic evaluation.
