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Cytogenetic evaluation and risk stratification are important steps in the classification of acute myeloid leukemia (AML) and also in determining the best treatment modality. Although cytogenetically normal acute myeloid leukemia (CN-AML) represents a large group of adult patients with AML (about 45% of AML patients), several mutations in some genes including FLT3, NPM1, CEBPA, and WT1 are associated with risk assessment and clinical outcome [1,2]. The WT1 gene is located on chromosome 11p13 and was detected first as a tumor-suppressor gene in Wilm’s tumor; it also has a regulatory role in normal and malignant hematopoiesis [3]. WT1 gene mutations in CN-AML were reported in about 10% of patients and its role as a sole prognostic factor is controversial [4,5,6]. The most important WT1 gene mutations associated with AML are clustered in the hotspot region of exon 7 and a synonymous single nucleotide polymorphism (SNP), rs16754, is also located in this region. Some studies were done for evaluation of WT1 rs16754 polymorphism effects on clinical response in AML patients. Most studies confirmed that rs16754 (A>G) in the hotspot region of exon 7 is a predictive independent positive prognostic factor in AML patients. Two meta-analyses were published for evaluation of these results. Megías-Vericat et al. [7] performed the first metaanalysis in this regards with a total of 3618 included patients from 14 cohort studies. They found that the overall survival (OS) at 5 years was significantly higher in patients with the variant allele (G) together with higher disease-free survival (DFS) with the variant allele. Although they did not find any significant effect of this variant on complete remission (CR), they stated that the lack of an observable effect could have been a result of the small number of studies that evaluated it. Long et al. [8] also published a meta-analysis in this regard, addressing 12 publications with 3903 included patients. Although some of the publications and included patients in those two studies may have been the same, they found the same results for the significant effects of WT1 rs16754 polymorphism on OS and relapse-free survival. In a newly published study Petiti et al. [9] also showed that patients with mutated genotypes (GG and GA) have a significantly better OS and event-free survival (EFS) compared with patients with wild AA mutation (84 vs. 9 months for OS and 23 vs. 3 months for EFS). They discussed that they used peptide nucleic acid-directed PCR clamping technology for this study.

Wilms Tumor-1 (WT1) rs16754 Polymorphism and Clinical Outcome in Acute Myeloid Leukemia