High expression of transcription factor 4 (TCF4) is an independent adverse prognostic factor in acute myeloid leukemia that could guide treatment decisions

Mutations in transcription factor 4 (TCF4) have recently been described in myeloid dysplastic syndromes (MDS) and acute myeloid leukemia (AML). We analyzed the impact of TCF4 mRNA expression on clinical outcome in AML patients (n=525). Patients with high TCF4 expression (TCF4high, defined as the 25% highest TCF4 expressors) had a significantly worse overall survival (OS) and event-free survival (EFS) than patients with lower TCF4 expression (TCF4low) (5-year OS 18% vs. 44%, P<0.0001; 5-year EFS 15% vs. 34%, P<0.0001, respectively). This was confirmed in an independent cohort (n=436). Multivariate analysis showed that TCF4high is an independent prognostic factor for OS and EFS in the whole cohort and in patients carrying a normal karyotype.