Prognostic Impact of Wilms' Tumour 1 Mutation in Patients with Acute Myeloid Leukaemia

To detect WT1 gene alterations among individuals diagnosed with acute myeloid leukaemia (AML) and investigate their relation to the response of induction therapy.

A descriptive study. Place and Duration of the Study: Department of Haematology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from June to December 2023.

The study enrolled all freshly diagnosed AML patients who underwent clinical, haematological, and molecular testing. Based on their WT1 mutation status, participants were categorised into distinct groups and assessed after four weeks of induction therapy. Independent t-test and chi-square tests were used to analyse the variables, while odds ratios (ORs) with 95% confidence intervals (CIs) were computed using cross-tabulation.

Within the cohort of 98 newly diagnosed AML cases, patients had a mean age of 36.5 years, showing a male predominance with a male-to-female ratio of 1.22:1. WT1 mutations were detected in 12 (12.2%) patients. These patients showed significantly lower haemoglobin, higher leucocyte counts, reduced platelet counts, and higher bone marrow blast percentage (p <0.05). Complete remission occurred in 75% of WT1-mutated versus 62.8% of wild-type patients (p = 0.408). Although not statistically significant, WT1 mutations demonstrated a trend towards a more aggressive presentation and poorer therapeutic response.

WT1 mutation in AML is associated with aggressive disease and less differentiated French-American-British (FAB) subtypes. Although remission rates were lower in WT1-mutated cases, the difference was not statistically significant. Larger prospective studies are needed to establish its prognostic significance and guide individualised therapy.

Acute myeloid leukaemia, WT1 mutation, Induction therapy, Prognosis, FAB classification.