Detection of PAX5 Overexpression By RNA-Seq for B-Cell Lineage Detection in Acute Lymphocytic Leukemia

Background: Paired-box Pax gene family protein 5 (PAX5)/B-cell specific activator protein (BSAP) is a transcription factor encoded by the PAX5 gene and has an essential role in B-cell differentiation and maturation. High PAX5 expression is detected ensures commitment to B-cell lineage. PAX5 is normally downregulated at the plasma cell stage of B-cell development. Complete or partial deletion of the PAX5 gene has been found as secondary event associated with BCR-ABL1 or TCF3-PBX1 fusions in Acute Lymphocytic Leukemia (ALL) cases. PAX5 expression is a diagnostic marker for B-cell lineage and may help quantify minimal residual disease in B-ALL. Lineage determination of leukemic blasts is most often performed by flow cytometry, but also by immunohistochemistry (IHC). Evaluation of PAX5 is most commonly available by IHC and is not widely performed by flow cytometry. In cases with limited specimen for evaluation or aberrant loss of some B-cell markers, determining quantitative levels of RNA from lineage-specific genes, such as PAX5, could be a valuable clinical diagnostic tool for ALL patients.