Despite recent progress in diagnosis and management, acute myeloid leukemia still remains a highly fatal disease which invites the needs for accurate predictors of clinical outcome. The aim of the present study was to explore gravin and survivin possible prognostic importance in adult patients with de novo AML by comparing their expression levels with initial tumor burden, response to induction therapy and overall survival. This study was conducted on 105 patients with de novo AML. RNA isolation from bone marrow aspirates or peripheral blood and cDNA preparation followed by quantitative real time RT-PCR were done to assess expression of gravin and survivin. Gravin expression was makedly down regulated (with a median of 0.02 in cases compared to 11.40 in controls) while survivin gene showed an over expression (with a median of 71.22 in cases compared to 0.12 in controls) in AML cases. There was a significant association between low gravin as well as high survivin expression and poor clinical outcome (p <0.001). Overall survival and disease free survival were significantly lower in patients with low gravin and high survivin expression (p <0.001). Survivin over expression and gravin down regulation were significantly associated with adverse clinical outcome and tendency to chemoresistance in acute myeloid leukemia and the degree of their expression derrangement has been found to be correlated with a lower complete remission rate and shorter overall and disease free survival which renders them as candidate prognostic markers and future targets for adjuvant immunotherapy.

Keywords- Gravin, Survivin, expression, prognosis, AML, Egyptian patients.

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