Overexpression of lymphoid enhancer‐binding factor‐1 ( LEF 1 ) is a novel favorable prognostic factor in childhood acute lymphoblastic leukemia

Summary Introduction Lymphoid enhancer‐binding factor‐1 ( LEF 1 ) is a target gene and central mediator of the Wnt signaling pathway. High LEF 1 expression has been reported as a prognostic marker in several types of hematologic malignancies of adult patients. Methods In this study, LEF 1 expression was analyzed by real‐time polymerase chain reaction ( PCR ) in 122 children with newly diagnosed ALL treated on the China NPCAC 97 protocols. Patients' samples were dichotomized at the median value of control group and divided into LEF 1 low and LEF 1 high groups. Results The LEF 1 mRNA levels in patients with ALL were significantly higher than those of normal controls, and the LEF 1 levels were dramatically decreased following induction therapy. In addition, LEF1 high patients had lower white blood cell ( WBC ) count at diagnosis and lower minimal residual disease ( MRD ) levels at the time of complete remission as compared to LEF 1 low patients. Finally, our studies showed that high LEF 1 expression is associated with favorable CR rate and overall survival ( OS ) in childhood ALL (5‐year OS : LEF 1 high 92% vs . LEF 1 low 73%, P  =   0.009). High LEF 1 level was associated with a favorable relapse‐free survival in standard‐risk patients and also related to a better OS within the subgroup of patients with BCR‐ABL‐negative ALL . Conclusion Overexpression of LEF 1 is a favorable prognostic factor in childhood ALL . The prognostic impact of LEF 1 may assist treatment stratification and suggest the need of alternative regimens.