This study further demonstrated how H19 acts in trans to modulate promoter methylation of key hematopoietic transcription factors like Runx1 and Spi1. In human AML cell lines, H19 knockdown caused a decrease in proliferation and increase in apoptosis (70, 72), while elevated expression correlated with poor treatment response and overall survival in patients (72). This evidence concerns the gene SPI1 and acute myeloid leukemia.