Serum neuron-specific enolase levels are upregulated in patients with acute lymphoblastic leukemia and are predictive of prognosis Cheng-cheng Liu1,2,3,*, Hua Wang1,2,3,*, Jing-hua Wang1,2,3,*, Liang Wang1,2,3, Qi-rong Geng1,2,3, Xiao-qin Chen1,2,3, Yue Lu1,2,3 1
Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P.R. China
State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, 510060, P.R. China
Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, P.R. China
These authors have contributed equally to this work
Correspondence to: Yue Lu, email: [email protected] Keywords: acute lymphoblastic leukemia, neuron-specific enolase, prognostic factor, biomarker, targeted therapy Received: February 25, 2016 Accepted: June 13, 2016 Published: July 07, 2016
ABSTRACT We explored the relationship between neuron-specific enolase (NSE) levels and the clinical features of acute lymphoblastic leukemia (ALL). Seventy ALL patients and forty-two healthy controls were enrolled in this study, and their serum NSE levels were measured using an electrochemiluminescence assay. The serum NSE concentration was higher in ALL patients than in healthy controls. In ALL patients, the mean serum NSE level declined after complete remission (CR) but increased with relapse. In addition, the mean serum NSE level was lower in the CR group than in the non-CR group. High NSE levels were associated with poorer progression-free and overall survival than low NSE levels. Serum NSE levels closely correlated with several clinical features, including the immunophenotype, risk stratification and serum lactate dehydrogenase levels. Multivariate analysis revealed that high NSE expression was an independent prognostic factor in adult ALL patients. NSE mRNA levels were also higher in ALL cell lines and bone marrow mononuclear cells from ALL patients than in control cells. These results suggested that NSE could be a clinical prognostic factor and a potential therapeutic target in ALL.
[4, 7, 8]. ALL is a disorder with clinical and biological heterogeneity. Further improvement in the outcome of ALL therapy will require the development of novel, targeted therapies with low toxicity. Additional biological markers remain to be discovered and will be required in order to optimize the classification and treatment of patients. Neuron-specific enolase (NSE) is the γ–γ or γ–δ dimer isoenzyme of enolase, an acidic protease that promotes the conversion of β-glycerophosphate into dihydroxyacetone phosphate during glycolysis, and is mainly found in mature neurons and cells of neuronal origin [9, 10]. Studies of NSE as a tumor marker have primarily focused on patients with small cell lung cancer and neuroblastoma [11-13]. NSE is not only a useful marker for disease aggressiveness, but also a prognostic factor. Elevated serum NSE expression has been found in 35% of non-neuroendocrine tumors, such as non-
INTRODUCTION Acute lymphoblastic leukemia (ALL) is a malignant disease of the bone marrow in which early lymphoid precursors proliferate and take the place of normal hematopoietic cells in the bone marrow [1, 2]. ALL mostly occurs in children, and the five-year event-free survival rate is greater than 80% in patients who receive standard protocol treatment . However, in adults, ALL is usually associated with a worse prognosis. Although intensified chemotherapy protocols may result in 70-90% remission in adult ALL patients, the long-term survival rate is extremely low, around 40% [4-6]. Consequently, the management of ALL is a challenge for both patients and clinicians. When a therapeutic plan is designed for adults with ALL, several clinical and genetic factors must be considered, such as age, white blood cell (WBC) count, minimal residual disease, and genetic features www.impactjournals.com/oncotarget
small cell lung carcinoma, breast cancer, lymphoma, and multiple myeloma [14-17]. We previously detected positive expression of serum NSE in 54% of patients with diffuse large B-cell lymphoma, and serum NSE expression closely correlated with Ann-Arbor stages, performance status, International Prognostic Index scores, and serum lactate dehydrogenase (LDH) levels. Serum NSE levels significantly declined in patients who responded to chemotherapy [18, 19]. However, no reports have indicated the whether serum NSE levels influence the clinical features and prognosis of ALL. In this study, we analyzed the serum NSE levels of 70 adult patients with newly diagnosed ALL and investigated their correlation with clinical outcomes. We also investigated the expression of NSE in ALL cell lines and bone marrow mononuclear cells (BM-MCs) from ALL patients.
elevated NSE group (>15.2 ng/mL), while the remaining 22 patients (31.4%) were classified into the low-NSE-level or normal NSE group (≤15.2 ng/mL). The WBC count, percentage of bone marrow blast and LDH levels were all higher in the elevated NSE group than in the normal NSE group (Table 2). At the time of diagnosis, CR, and relapse, we analyzed the serum NSE levels of patients who relapsed after CR. The mean serum NSE level declined significantly after induction therapy (before treatment: 33.24 ± 4.79 ng/mL, after complete remission: 15.11 ± 2.15 ng/mL; n = 15, P = 0.013) but increased with relapse (28.69 ± 4.46 ng/mL) (Figure 3).
Correlation of NSE expression with survival The median follow-up time was 36 months (range 9-108 months). The five-year progression-free survival (PFS) and overall survival (OS) rates were both significantly lower in the high-NSE-level group than in the low-NSE-level group (P
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