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Background  Recent studies have identified  myocyte enhancer factor 2C  ( MEF2C ) as cooperating oncogene in acute myeloid leukemia (AML) and suggested a contribution to the aggressive nature of at least some subtypes of AML, raising the possibility that  MEF2C  could serve as marker of poor-risk AML and, therefore, have prognostic significance.    Methods  To test this hypothesis, we retrospectively quantified  MEF2C  expression in pretreatment bone marrow specimens in participants of the AAML0531 trial by reverse-transcriptase polymerase chain reaction and correlated expression levels with disease characteristics and clinical outcome.    Results  In all 751 available patient specimens,  MEF2C  messenger RNA (mRNA) was detectable and varied >3000-fold relative to  β-glucuronidase . Patients with the highest relative  MEF2C  expression (4th quartile) less likely achieved a complete remission after one course of chemotherapy than the other patients (67 vs .  78 %,  P  = 0.005). They also had an inferior overall survival ( P  = 0.014; at 5 years 55 ± 8 vs. 67 ± 4 %), inferior event-free survival ( P  < 0.001; at 5 years 38 ± 7 vs. 54 ± 4 %), and higher relapse risk than patients within the lower 3 quartiles of  MEF2C  expression ( P  < 0.001; at 5 years 53 ± 9 vs. 35 ± 5 %). These differences were accounted for by lower prevalence of cytogenetically/molecularly defined  low-risk  disease (16 vs .  46 %,  P  < 0.001) and higher prevalence of  standard-risk  disease (68 vs. 42 %,  P  < 0.001) in patients with high  MEF2C  expression, suggesting that  MEF2C  cooperates with additional pathogenic abnormalities.    Conclusions  High  MEF2C  expression identifies a subset of AML patients with adverse-risk disease features and poor outcome. With confirmation that high  MEF2C  mRNA expression leads to overexpression of MEF2C protein, these findings provide the rationale for therapeutic targeting of  MEF2C  transcriptional activation in AML.

journal of hematology and oncology

High expression of myocyte enhancer factor 2C (MEF2C) is associated with adverse-risk features and poor outcome in pediatric acute myeloid leukemia: a report from the Children’s Oncology Group