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Evaluation of survivin gene expression as a prognostic biomarker in pediatric B-acute lymphoblastic leukemia

Objective The aim of this study was to evaluate the level of survivin mRNA expression in Egyptian patients with acute pediatric lymphoblastic leukemia and to outline any significant relation between the level of survivin expression and the clinical and hematological findings in those patients. Background Survivin, a unique member of the inhibitor of apoptosis protein family, plays an important role in regulating both apoptosis and cell division and was found to be highly expressed in various kinds of tumors. Patients and methods Survivin expression was quantitatively determined by real-time (RT) PCR in 30 newly diagnosed acute lymphoblastic leukemia (B-ALL) pediatric patients before and after induction therapy and in 15 age-matched and sex-matched immune thrombocytopenic purpura individuals serving as a control group. Results A highly significant elevation (P < 0.001) was found in survivin mRNA level in B-ALL children at diagnosis compared with controls. After induction therapy, a significant decrease of survivin mRNA expression level was found in B-ALL patients compared with those at diagnosis (P < 0.001). Survivin mRNA level was significantly higher in the nonsurvived group and in patients with induction failure compared with patients with favorable response (P = 0.01). In addition, a positive correlation was found between survivin mRNA expression level and initial leukocyte count (r = 0.72; P < 0.001) and bone marrow blast cells percent (r = 0.44; P = 0.015). Conclusion Survivin is overexpressed in B-ALL at presentation and may be used as a prognostic marker for ALL in pediatric patients.