Co-overexpression of CDC27 and PD-L1 defines an ultra–high-risk subgroup of acute myeloid leukemia in an Egyptian cohort

Acute myeloid leukemia (AML) is a heterogeneous hematologic malignancy characterized by uncontrolled proliferation of leukemic cells. Emerging evidence suggests that dysregulation of cell-cycle regulators may interact with immune checkpoint pathways; however, this relationship remains insufficiently explored in AML. To evaluate the expression of CDC27 and PD-L1 in adult AML patients and assess their clinicopathological and prognostic significance. This case – control study included 80 participants: 40 newly diagnosed adult AML patients and 40 age- and sex-matched healthy controls. Gene expression levels of CDC27 and PD-L1 in bone marrow mononuclear cells were quantified using real-time polymerase chain reaction (RT-PCR). Survival analysis was performed and Patients were stratified according to median expression levels. Univariate and multivariate Cox proportional hazards regression analyses were conducted to identify independent prognostic factors. CDC27 and PD-L1 expression levels were significantly higher in AML patients compared with controls (p = 0.001 and p = 0.005, respectively). Both markers were associated with adverse clinical features and reduced overall survival. Multivariate analysis identified CDC27 expression as an independent predictor of mortality. Conclusion: CDC27 and PD-L1 overexpression is associated with aggressive disease characteristics and poor survival in AML patients.