A 69 long non-coding RNA signature predicts relapse and acts as independent prognostic factor in pediatric AML.

Risk stratification using genetics and minimal residual disease (MRD) has allowed to increase the cure rates of pediatric acute myeloid leukemia (pedAML) up to 70% in contemporary protocols. Nevertheless, approximately 30% of patients still experience relapse, indicating a need to optimize stratification strategies. Recently, long non-coding RNA (lncRNA) expression has been shown to hold prognostic power in multiple cancer types. Here, we aimed at refining relapse prediction in pedAML using lncRNA expression. We built a relapse-related lncRNA prognostic signature, named AMLlnc69, using 871 pedAML patients transcriptomes obtained from the Therapeutically Applicable Research To Generate Effective Treatments (TARGET) repository. We identified a 69 lncRNA signature AMLlnc69 that is highly predictive of relapse-risk (c-index = 0.73), with area under the ROC curve (AUC) values for predicting the 1-, 2-, and 3-year relapse-free survival (RFS) of 0.78, 0.77, and 0.77, respectively. The internal validation using a bootstrap method (resampling times = 1000) resulted in a c-index of 0.72 and AUC values for predicting the 1-, 2-, and 3-year RFS of 0.77, 0.76, and 0.76, respectively. Through a Cox regression analysis, AMLlnc69, NPM mutation and WBC at diagnosis were identified as independent predictors of RFS. Finally, a nomogram was build using these two parameters, showing a c-index of 0.80 and 0.71 after bootstrapping (n =1000). In conclusion, the identified AMLlnc69 will, after prospective validation, add important information to guide management of pedAML patients. The nomogram is a promising tool for easy stratification of patients into a novel scheme of relapse-risk groups.