Prognostic Value of BAALC Expression in Pediatric Acute Myeloid Leukemia: A Systematic Review

Background: Acute myeloid leukemia (AML) is a malignant disorder involving blood cells, characterized by obstructed or distorted differentiation of hematopoietic stem cells. In cytogenetically normal AML (CN AML), molecular abnormalities in NPM, FLT3, CEBPA, and BAALC genes are observed. Initially, high BAALC (Brain and Acute Leukemia Cytoplasmic gene) expression was introduced in a study on AML cases with trisomy 8. The present systematic review aimed to determine the prognostic value of BAALC expression in CN-AML patients within the age range of 1 month to 15 years. Materials and Methods: In this systematic review, scientific databases including PubMed, Scopus, Embase, ISI, and Cochrane Library were searched. All the evaluated retrospective studies focused on the prognostic value of BAALC expression. Results: Overall, BAALC expression was reported in 30-60% of AML patients (mean=45%). High expression of BAALC gene was reported in M0, M1, and M2 subtypes of pediatric AML. In only one study, in addition to these subtypes, M4 was also reported (12.5% of cases). Conclusion: This systematic review resulted in a significant association between high BAALC expression and poor response to chemotherapy in pediatric AML. However, OS (Overall Survival) and EFS (Event - Free Survival) findings were contradictory, relapse and death increase in the presence of high BAALC expression. Therefore, BAALC expression could be considered as a clinical prognostic marker for the treatment of AML patients. Further efficient prognostic indicators should be identified in order to gather information about therapeutic strategies for AML and risk analysis in these patients.