Cytogenetic abnormalities are currently the most important predictors of response and clinical outcome for patients with acute myeloid leukemia (AML) or advanced-stage myelodysplastic syndrome (MDS). Because clinical outcomes vary markedly within cytogenetic subgroups, additional biological markers are needed for risk stratification.
We assessed the utility of measuring pretreatment proteasome chymotrypsin-like (Ch-L), caspase-like (Cas-L), and trypsin-like (Tr-L) activities in plasma to predict response and survival of patients with AML (n=174) or advanced-stage MDS (n=52).
All three enzymatic activities were significantly (P<0.001) increased in the plasma of patients with AML and MDS as compared with normal controls. Both Ch-L and Cas-L activities, but not Tr-L activity correlated with outcome. Ch-L and Cas-L activities, but not Tr-L activity predicted response in univariate analysis (P = 0.002). However, only Ch-L activity was independent predictor of response from age grouping (< vs ≥70 years), cytogenetics, and BUN in multivariate analysis. Similarly, both Ch-L and Cas-L activities, but not Tr-L activity were predictors of overall survival in univariate analysis (P <0.0001), but only Ch-L activity was independent of cytogenetics, age, performance status, BUN, and beta-2 microglobulin in multivariate Cox regression models. Ch-L activity was also a strong independent predictor of survival in patients with intermediate karyotype (n=124).
Measuring plasma chymotrypsin-like activity may provide a powerful biomarker for risk stratification in patients with AML and advanced-stage MDS, including those with normal karyotype.