HOX11 gene overexpression is associated with recurrence of acute B lymphoblastic leukaemia

This research aimed to elucidate the association of Homeo Box 11 (HOX11) gene overexpression with refractory acute B-cell lymphoblastic leukaemia (B-ALL). In this investigation, 209 patients with B-ALL, who were treated in Guangdong Province between 2019 and 2024, were included. At the initial diagnosis, the RNA was obtained from bone marrow for genetic testing via Real-time Quantitative Polymerase Chain Reaction (RQ-PCR). Furthermore, the clinical data were acquired and the association of HOX11 with these clinical features and gene alterations was analysed. Finally, the relationship between gene alterations and progression-free survival (PFS) was analysed. Of the 209 B-ALL patients, 42 (20.1%) had recurrent disease. Twenty-six (12.4%) had HOX11 overexpression, of which 10 had recurrent disease. Furthermore, the HOX11 overexpression patients indicated TP53 concomitant of 23.07%, whereas the HOX11 low-expression patients showed TP53 concomitant of 8.7% (p < 0.05). Logistic regression indicated lower WBC counts and higher recurrence rates in the HOX11 overexpression group (p < 0.05). PFS analysis indicated that the HOX11 overexpression group and KMT2A::AFF1 group were associated with higher disease recurrence (p < 0.05). Cox regression analysis showed that HOX11 was an independent risk factor affecting PFS (p = 0.041). These findings are the first to demonstrate an association between HOX11 overexpression and recurrent B-ALL.