EWSR1 as a candidate prognostic indicator in acute myeloid leukemia.

[BACKGROUND] Ewing sarcoma breakpoint region 1(EWSR1) rearrangements have been repeatedly observed in acute myeloid leukemia (AML). However, the clinical impact of EWSR1 expression is still unclear in AML. Therefore, we explored the prognostic significance of EWSR1 in AML.

[METHODS] Bone marrow samples from 150 AML patients and 29 normal controls were collected, and qRT-PCR detected EWSR1 expression. The correlation between EWSR1 expression and clinical data in non-acute promyelocytic leukemia (non-APL) AML patients was analysed. A model was constructed for predicting 1-year, 2-year, and 3-year overall survival (OS). The molecular mechanisms of EWSR1 in AML were preliminarily explored through bioinformatics analysis.

[RESULTS] EWSR1 expression was upregulated in AML compared with normal controls ( = 0.009). High EWSR1 expression was associated with the European Leukemia Net (2022-ELN) adverse-risk non-APL AML ( = 0.006). Patients with high EWSR1 expression had shorter OS (294 days VS 812 days, < 0.001) and shorter event free survival (EFS) (197 days VS 660 days,  = 0.001). Multivariate Cox regression analysis showed that high EWSR1 expression was an independent adverse prognostic factor for OS and EFS (<0.05). The receiver operating characteristic curve, calibration curve and decision curve analysis showed that the model had better discrimination power for predicting 1-year, 2-year, and 3-year OS. The bioinformatics analysis suggested that EWSR1 may be involved in the progression of AML by regulating the cell cycle, senescence, apoptosis, PD-1 checkpoint pathway, and immune cell infiltration.

[CONCLUSIONS] EWSR1 could be a powerful prognostic indicator for clinical strategy selection in AML. The prediction model may effectively predict the OS of non-APL AML.