Prognostic impact of CEBPA bZIP domain mutation in acute myeloid leukemia

Abstract

Mutations of CCAAT/enhancer–binding protein alpha (CEBPAmu) are found in 10% to 15% of de novo acute myeloid leukemia (AML) cases. Double-mutated CEBPA (CEBPAdm) is associated with a favorable prognosis; however, single-mutated CEBPA (CEBPAsm) does not seem to improve prognosis. We investigated CEBPAmu for prognosis in 1028 patients with AML, registered in the Multi-center Collaborative Program for Gene Sequencing of Japanese AML. It was found that CEBPAmu in the basic leucine zipper domain (bZIP) was strongly associated with a favorable prognosis, but CEBPAmu out of the bZIP domain was not. The presence of CEBPAmu in bZIP was a strong indicator of a higher chance of achieving complete remission (P, .001), better overall survival (OS; P, .001) and a lower risk of relapse (P, .001). The prognostic significance of CEBPAmu in bZIP was also observed in the subgroup with CEBPAsm (all patients: OS, P 5 .008; the cumulative incidence of relapse, P 5 .063; patients aged #70 years and with intermediate-risk karyotype: OS, P 5 .008; cumulative incidence of relapse, P 5 .026). Multivariate analysis of 744 patients aged #70 years showed that CEBPAmu in bZIP was the most potent predictor of OS (hazard ratio, 0.3287; P, .001). CEBPAdm was validated as a cofounding factor, which was overlapping with CEBPAmu in bZIP. In summary, these findings indicate that CEBPAmu in bZIP is a potent marker for AML prognosis. It holds potential in the refinement of treatment stratification and the development of targeted therapeutic approaches in CEBPA-mutated AML.