bims-tremyl Biomed News
on Therapy resistance biology in myeloid leukemia
Issue of 2021–08–15
twenty papers selected by
Paolo Gallipoli, Barts Cancer Institute, Queen Mary University of London
  1. Indeterminate and oncogenic potential: CHIP vs CHOP mutations in AML with NPM1 alteration.
  2. Therapeutic Targeting of Mesothelin with Chimeric Antigen Receptor T Cells in Acute Myeloid Leukemia.
  3. Evi1 Upregulates Fbp1 and Supports Progression of Acute Myeloid Leukemia through Pentose Phosphate Pathway Activation.
  4. Molecular Characterization and Clinical Treatment of Acute Myeloid Leukemia (AML) and Myelodysplastic Syndromes (MDS) Patients With TP53 Mutation.
  5. Prognostic Impact of Concurrent DNMT3A, FLT3 and NPM1 Gene Mutations in Acute Myeloid Leukemia Patients.
  6. Interacting evolutionary pressures drive mutation dynamics and health outcomes in aging blood.
  7. Regulatory T cells promote the stemness of leukemia stem cells through IL10 cytokine-related signaling pathway.
  8. The evolution of hematopoietic cells under cancer therapy.
  9. Advances in culture methods for acute myeloid leukemia research.
  10. A genetic screen in Drosophila uncovers the multifaceted properties of the NUP98-HOXA9 oncogene.
  11. The requirement for pyruvate dehydrogenase in leukemogenesis depends on cell lineage.
  12. Hsf1 promotes hematopoietic stem cell fitness and proteostasis in response to ex vivo culture stress and aging.
  13. Dopamine signaling regulates hematopoietic stem and progenitor cell function.
  14. The Real-Life Efficacy of Fixed-Dose Hypomethylating Agents in Older Patients With Acute Myeloid Leukemia: A 10-Year Experience.
  15. Clinical and molecular characterization of myeloid sarcoma without medullary leukemia.
  16. 3-Ketodihydrosphingosine reductase maintains ER homeostasis and unfolded protein response in leukemia.
  17. Measurable residual disease including AML leukemia stem cell flow evaluation of CPX-351 therapy by multi-parameter flow cytometry.
  18. Is resistance to targeted therapy in cancer inevitable?
  19. Cycling cancer persister cells arise from lineages with distinct programs.
  20. Comprehensive RNA editome reveals that edited Azin1 partners with DDX1 to enable hematopoietic stem cell differentiation.
  1. Leukemia. 2021 Aug 10.
    Indeterminate and oncogenic potential: CHIP vs CHOP mutations in AML with NPM1 alteration.
    Luca Vincenzo Cappelli, Manja Meggendorfer, Constance Baer, Niroshan Nadarajah, Stephan Hutter, Sabine Jeromin, Frank Dicker, Wolfgang Kern, Torsten Haferlach, Claudia Haferlach, Alexander Höllein.
      In AML patients, recurrent mutations were shown to persist in remission, however, only some have a prognostic value and persistent mutations might therefore reflect a re-established premalignant state or truly active disease causing relapse. We aimed to dissect the nature of co-mutations in NPM1 mutated AML where the detection of NPM1 transcripts allows highly specific and sensitive detection of complete molecular remission (CMR). We analysed 150 consecutive patients who achieved CMR following intensive treatment by next generation sequencing on paired samples at diagnosis, CMR and relapse (38/150 patients). Patients with persistence or the acquisition of non-DTA (DNMT3A, TET2, ASXL1) mutations at CMR (23/150 patients, 15%) have a significantly worse prognosis (EFS HR = 2.7, p = 0.003; OS HR = 3.6, p = 0.012). Based on clonal evolution analysis of diagnostic, CMR and relapse samples, we redefine pre-malignant mutations and include IDH1, IDH2 and SRSF2 with the DTA genes in this newly defined group. Only the persistence or acquisition of CHOP-like (clonal hematopoiesis of oncogenic potential) mutations was significantly associated with an inferior outcome (EFS HR = 4.5, p = 0.0002; OS HR = 5.5, p = 0.002). Moreover, the detection of CHOP-like mutations at relapse was detrimental (HR = 4.5, p = 0.01). We confirmed these findings in a second independent whole genome sequencing cohort.
    DOI:  https://doi.org/10.1038/s41375-021-01368-1
  2. Clin Cancer Res. 2021 Aug 11. pii: clincanres.1546.2021. [Epub ahead of print]
    Therapeutic Targeting of Mesothelin with Chimeric Antigen Receptor T Cells in Acute Myeloid Leukemia.
    Quy Le, Sommer Castro, Thao Tang, Anisha M Loeb, Tiffany Hylkema, Cyd McKay, LaKeisha Perkins, Shivani Srivastava, Lindsey Call, Jenny L Smith, Amanda Leonti, Rhonda Ries, Laura Pardo, Michael R Loken, Colin Correnti, Salvatore Fiorenza, Cameron J Turtle, Stanley Riddell, Katherine Tarlock, Soheil Meshinchi.
       PURPOSE: We previously identified mesothelin (MSLN) as highly expressed in a significant fraction of acute myeloid leukemia (AML) but entirely silent in normal hematopoiesis, providing a promising antigen for immunotherapeutic targeting that avoids hematopoietic toxicity. Given that T cells genetically modified to express chimeric antigen receptors (CARs) are effective at eradicating relapsed/refractory acute lymphocytic leukemia, we developed MSLN-directed CAR T cells for pre-clinical evaluation in AML.
    EXPERIMENTAL DESIGN: The variable light (VL) and heavy (VH) sequences from the MSLN-targeting SS1P immunotoxin were used to construct the single-chain variable fragment of the standard CAR containing 41-BB co-stimulatory and CD3Zeta stimulatory domains. The pre-clinical efficacy of MSLN CAR T cells was evaluated against AML cell lines and patient samples expressing various levels of MSLN in vitro and in vivo Results: We demonstrate that MSLN is expressed on the cell surface of AML blasts and leukemic stem cell-enriched CD34+CD38- subset but not on normal hematopoietic stem and progenitor cells (HSPCs). We further establish that MSLN CAR T cells are highly effective in eliminating MSLN-positive AML cells in cell line- and patient-derived xenograft models. Importantly, MSLN CAR T cells can target and eradicate CD34+CD38- cells without impacting the viability of normal HSPCs. Finally, we show that CAR T cell functionality can be improved by inhibition of the ADAM17 metalloprotease that promotes shedding of MSLN.
    CONCLUSIONS: These findings demonstrate that MSLN is a viable target for CAR T therapy in AML and that inhibiting MSLN shedding is a promising approach to improve CAR T efficacy.
    DOI:  https://doi.org/10.1158/1078-0432.CCR-21-1546
  3. Cancer Sci. 2021 Aug 07.
    Evi1 Upregulates Fbp1 and Supports Progression of Acute Myeloid Leukemia through Pentose Phosphate Pathway Activation.
    Hideaki Mizuno, Junji Koya, Yosuke Masamoto, Yuki Kagoya, Mineo Kurokawa.
      Evi1 is a transcription factor essential for the development as well as progression of acute myeloid leukemia (AML) and high Evi1 AML is associated with extremely poor clinical outcome. Since targeting metabolic vulnerability is the emerging therapeutic strategy of cancer, we herein investigated a novel therapeutic target of Evi1 by analyzing transcriptomic, epigenetic and metabolomic profiling of mouse high Evi1 leukemia cells. We revealed that Evi1 overexpression and Evi1-driven leukemic transformation upregulate transcription of gluconeogenesis enzyme Fbp1 and other pentose phosphate enzymes with interaction between Evi1 and enhancer region of these genes. Metabolome analysis using Evi1-overexpressing leukemia cells uncovered pentose phosphate pathway upregulation by Evi1 overexpression. Suppression of Fbp1 as well as pentose phosphate pathway enzymes by shRNA mediated knockdown selectively decreased Evi1-driven leukemogenesis in vitro. Moreover, pharmacological or shRNA-mediated Fbp1 inhibition in secondarily transplanted Evi1-overexpressing leukemia mouse significantly decreased leukemia cell burden. Collectively, targeting FBP1 is a promising therapeutic strategy of high Evi1 AML.
    Keywords:  Acute Myeloid Leukemia; Gluconeogenesis; Oncogene; Pentose phosphate pathway; Transcription Factors
    DOI:  https://doi.org/10.1111/cas.15098
  4. Clin Lymphoma Myeloma Leuk. 2021 Jul 13. pii: S2152-2650(21)00278-0. [Epub ahead of print]
    Molecular Characterization and Clinical Treatment of Acute Myeloid Leukemia (AML) and Myelodysplastic Syndromes (MDS) Patients With TP53 Mutation.
    Yanfen Li, Hua Wan, Yu Jing.
       BACKGROUND: Mutations in TP53 in myeloid neoplasms patients have been associated with poor prognosis. Effective treatments to these patients remain unclear.
    PATIENTS AND METHODS: In this study, we retrospectively analyzed diagnostic and outcomes of 31 Acute Myeloid leukemia (AML) and 9 Myelodysplastic syndromes (MDS) patients with TP53 mutation at our hospital from September 2015 to October 2020.
    RESULTS: A total of 42 variants (28 unique variants) in the coding region of TP53 gene were identified, and most were missense mutation (34 of 42, 81%). The median overall survival (OS) was 8 months for the AML patients (1-32 months) and 7 months for the MDS patients (3-27 months). There were 35 and 13 patients underwent frontline chemical therapy and Allo-HSCT, respectively. The overall response rate was 45.3% (16/35) for the frontline treatment. There was no significant difference between intensive and low-intensity regimens on either response to the frontline treatment (P = .255) or overall survival (P = .078). Patients, who achieved complete or partial remission at the frontline treatment, presented a higher survival than patients in non-remission, no matter transplant or not.
    CONCLUSION: This study corroborates that improving the response to the first-line treatment could prolong the survival of myeloid neoplasms patients with TP53 mutation. Allo-HSCT could be a curative option for patients with TP53 mutation, when in complete remission during the first-line treatment.
    Keywords:  Allo-HSCT.; Low-intensity treatment; Myeloid neoplasms; Overall survival; first-line treatment
    DOI:  https://doi.org/10.1016/j.clml.2021.07.007
  5. Clin Lymphoma Myeloma Leuk. 2021 Jul 16. pii: S2152-2650(21)00281-0. [Epub ahead of print]
    Prognostic Impact of Concurrent DNMT3A, FLT3 and NPM1 Gene Mutations in Acute Myeloid Leukemia Patients.
    Heba Allah E Abd Elrhman, Yomna M El-Meligui, Saffaa M Elalawi.
       BACKGROUND: Acute myeloid leukemia (AML) is one of the rapidly progressing malignancies which is characterized by unregulated proliferation of hematopoietic precursors. Technological improvements enhanced the availability of genetic AML biomarkers. The clinical relevance of these molecular markers for AML diagnosis, planning of therapy and risk stratification are increasing evidently.
    METHODS: In current study, one hundred newly diagnosed AML patients before receiving induction chemotherapy were included, they were subjected to clinical examination, cytochemical and morphological analysis of blood cells, flow cytometric, cytogenetic and molecular genetic analysis for detection of NPM1, FLT3-ITD and DNMT3A mutations. Direct sequencing analysis for detection of NPM1 and DNMT3A genes mutations were done. FLT3 /ITD gene mutation was detected by gel electrophoresis after PCR amplification.
    RESULTS: According to genetic markers, our AML patients are classified in to further 8groups. AML patients with three DNMT3A/FLT3/NPM1 gene mutations (AML DNMT3A /FLT3/NPM1) this group of patients presented with a heavy disease burden, had an elevated WBC in comparison to other groups (70 vs. 41 × 103/μL; P = .019), and BM blast counts (71% vs. 55.6%, P < .02). When comparing eight groups for death event there were significant difference among groups; P = .005, group 1 (AML DNMT3A /FLT3/NPM1) showed rapid decline of the cumulative overall survival. There was a significant difference among 8 groups as regards response to treatment after 14 days (P = .02), group 7 AML with (DNMT3A +NMP1) gene mutations showed better response to treatment (100%), groups 1 and 3 AML with (NPM1+DNMT3A +NMP1) gene mutations and AML with isolated FLT3-ITD showed no response to treatment after 14 days. And as regards response to treatment after 28 days, the eight groups showed no significant difference (P = .14).
    CONCLUSION: Our study supports adverse prognostic effect of presence of DNMT3A gene mutation either alone or in the presence of FLT3 and/or NPM1 gene mutations.
    Keywords:  AML; DNMT3A; FLT3-ITD; NPM1
    DOI:  https://doi.org/10.1016/j.clml.2021.07.011
  6. Nat Commun. 2021 Aug 13. 12(1): 4921
    Interacting evolutionary pressures drive mutation dynamics and health outcomes in aging blood.
    Kimberly Skead, Armande Ang Houle, Sagi Abelson, Mawusse Agbessi, Vanessa Bruat, Boxi Lin, David Soave, Liran Shlush, Stephen Wright, John Dick, Quaid Morris, Philip Awadalla.
      Age-related clonal hematopoiesis (ARCH) is characterized by age-associated accumulation of somatic mutations in hematopoietic stem cells (HSCs) or their pluripotent descendants. HSCs harboring driver mutations will be positively selected and cells carrying these mutations will rise in frequency. While ARCH is a known risk factor for blood malignancies, such as Acute Myeloid Leukemia (AML), why some people who harbor ARCH driver mutations do not progress to AML remains unclear. Here, we model the interaction of positive and negative selection in deeply sequenced blood samples from individuals who subsequently progressed to AML, compared to healthy controls, using deep learning and population genetics. Our modeling allows us to discriminate amongst evolutionary classes with high accuracy and captures signatures of purifying selection in most individuals. Purifying selection, acting on benign or mildly damaging passenger mutations, appears to play a critical role in preventing disease-predisposing clones from rising to dominance and is associated with longer disease-free survival. Through exploring a range of evolutionary models, we show how different classes of selection shape clonal dynamics and health outcomes thus enabling us to better identify individuals at a high risk of malignancy.
    DOI:  https://doi.org/10.1038/s41467-021-25172-8
  7. Leukemia. 2021 Aug 11.
    Regulatory T cells promote the stemness of leukemia stem cells through IL10 cytokine-related signaling pathway.
    Yingxi Xu, Junli Mou, Ying Wang, Wei Zhou, Qing Rao, Haiyan Xing, Zheng Tian, Kejing Tang, Min Wang, Jianxiang Wang.
      Regulatory T cells (Tregs) could maintain the characteristics of stem cells and inhibit the differentiation of normal hematopoietic stem/progenitor cells. Recent studies have shown that Tregs, as an important component of acute myeloid leukemia (AML) microenvironments, can help AML cells to evade immune surveillance. However, their function in directly regulating the stemness of AML cells remains elusive. In this study, the increased stemness of AML cells promoted by Tregs was verified in vitro and in vivo. The cytokines released by Tregs were explored, the highly expressed anti-inflammatory cytokine IL10 was found, which could promote the stemness of AML cells through the activation of PI3K/AKT signal pathway. Moreover, disrupting the IL10/IL10R/PI3K/AKT signal in AML/ETO c-kitmut (A/Ec) leukemia mice could prolong the mice survival and reduce the stemness of A/Ec leukemia cells. Finally, it was confirmed in patient samples that the proportion of Tregs to leukemia stem cells (LSCs) was positively correlated, and in CD34+ primary AML cells, the activation of PI3K/AKT was stronger in patients with high Tregs' infiltration. After rhIL10 treatment, primary AML cells showed increased activation of PI3K/AKT signaling. Therefore, blocking the interaction between Tregs and AML cells may be a new approach to target LSCs in AML treatment.
    DOI:  https://doi.org/10.1038/s41375-021-01375-2
  8. Nat Commun. 2021 08 10. 12(1): 4803
    The evolution of hematopoietic cells under cancer therapy.
    Oriol Pich, Albert Cortes-Bullich, Ferran Muiños, Marta Pratcorona, Abel Gonzalez-Perez, Nuria Lopez-Bigas.
      Chemotherapies may increase mutagenesis of healthy cells and change the selective pressures in tissues, thus influencing their evolution. However, their contributions to the mutation burden and clonal expansions of healthy somatic tissues are not clear. Here, exploiting the mutational footprint of some chemotherapies, we explore their influence on the evolution of hematopoietic cells. Cells of Acute Myeloid Leukemia (AML) secondary to treatment with platinum-based drugs show the mutational footprint of these drugs, indicating that non-malignant blood cells receive chemotherapy mutations. No trace of the 5-fluorouracil (5FU) mutational signature is found in AMLs secondary to exposure to 5FU, suggesting that cells establishing the leukemia could be quiescent during treatment. Using the platinum-based mutational signature as a barcode, we determine that the clonal expansion originating the secondary AMLs begins after the start of the cytotoxic treatment. Its absence in clonal hematopoiesis cases is consistent with the start of the clonal expansion predating the exposure to platinum-based drugs.
    DOI:  https://doi.org/10.1038/s41467-021-24858-3
  9. Oncoscience. 2021 ;8 82-90
    Advances in culture methods for acute myeloid leukemia research.
    Krishnapriya Syama, Eman M Hassan, Shan Zou.
      Conventional suspension cultures have been used in Acute Myeloid Leukemia (AML) research to study its biology as well as to screen any drug molecules, since its inception. Co-culture models of AML cells and other stromal cells as well as 3 dimensional (3D) culture models have gained much attention recently. These culture models try to recapitulate the tumour microenvironment and are found to be more suitable than suspension cultures. Though animal models are being used, they require more time, effort and facilities and hence, it is essential to develop cell culture models for high-throughput screening of drugs. Here, we discuss a new co-culture model developed by our research group involving acute myeloid leukemia (AML) cells and stimulated macrophages. Other studies on co-culture systems and relevance of 3D culture in leukemic research in understanding the pathology and treatment of leukemia are also reviewed.
    Keywords:  3D culture; CD47; calreticulin; co-culture; cytokines
    DOI:  https://doi.org/10.18632/oncoscience.540
  10. PLoS Genet. 2021 Aug 12. 17(8): e1009730
    A genetic screen in Drosophila uncovers the multifaceted properties of the NUP98-HOXA9 oncogene.
    Gwenaëlle Gavory, Caroline Baril, Gino Laberge, Gawa Bidla, Surapong Koonpaew, Thomas Sonea, Guy Sauvageau, Marc Therrien.
      Acute myeloid leukemia (AML) underlies the uncontrolled accumulation of immature myeloid blasts. Several cytogenetic abnormalities have been associated with AML. Among these is the NUP98-HOXA9 (NA9) translocation that fuses the Phe-Gly repeats of nucleoporin NUP98 to the homeodomain of the transcription factor HOXA9. The mechanisms enabling NA9-induced leukemia are poorly understood. Here, we conducted a genetic screen in Drosophila for modifiers of NA9. The screen uncovered 29 complementation groups, including genes with mammalian homologs known to impinge on NA9 activity. Markedly, the modifiers encompassed a diversity of functional categories, suggesting that NA9 perturbs multiple intracellular events. Unexpectedly, we discovered that NA9 promotes cell fate transdetermination and that this phenomenon is greatly influenced by NA9 modifiers involved in epigenetic regulation. Together, our work reveals a network of genes functionally connected to NA9 that not only provides insights into its mechanism of action, but also represents potential therapeutic targets.
    DOI:  https://doi.org/10.1371/journal.pgen.1009730
  11. Cell Metab. 2021 Aug 03. pii: S1550-4131(21)00332-6. [Epub ahead of print]
    The requirement for pyruvate dehydrogenase in leukemogenesis depends on cell lineage.
    Sojeong Jun, Swetha Mahesula, Thomas P Mathews, Misty S Martin-Sandoval, Zhiyu Zhao, Elena Piskounova, Michalis Agathocleous.
      Cancer cells are metabolically similar to their corresponding normal tissues. Differences between cancers and normal tissues may reflect reprogramming during transformation or maintenance of the metabolism of the specific normal cell type that originated the cancer. Here, we compare glucose metabolism in hematopoiesis and leukemia. Thymus T cell progenitors were glucose avid and oxidized more glucose in the tricarboxylic acid cycle through pyruvate dehydrogenase (PDH) as compared with other hematopoietic cells. PDH deletion decreased double-positive T cell progenitor cells but had no effect on hematopoietic stem cells, myeloid progenitors, or other hematopoietic cells. PDH deletion blocked the development of Pten-deficient T cell leukemia, but not the development of a Pten-deficient myeloid neoplasm. Therefore, the requirement for PDH in leukemia reflected the metabolism of the normal cell of origin independently of the driver genetic lesion. PDH was required to prevent pyruvate accumulation and maintain glutathione levels and redox homeostasis.
    Keywords:  T cell leukemia; double-positive thymocytes; glycolysis; hematopoietic stem cells; metabolism; pyruvate dehydrogenase; thymus
    DOI:  https://doi.org/10.1016/j.cmet.2021.07.016
  12. Cell Stem Cell. 2021 Aug 06. pii: S1934-5909(21)00294-0. [Epub ahead of print]
    Hsf1 promotes hematopoietic stem cell fitness and proteostasis in response to ex vivo culture stress and aging.
    Miriama Kruta, Mary Jean Sunshine, Bernadette A Chua, Yunpeng Fu, Ashu Chawla, Christopher H Dillingham, Lorena Hidalgo San Jose, Bijou De Jong, Fanny J Zhou, Robert A J Signer.
      Maintaining proteostasis is key to resisting stress and promoting healthy aging. Proteostasis is necessary to preserve stem cell function, but little is known about the mechanisms that regulate proteostasis during stress in stem cells, and whether disruptions of proteostasis contribute to stem cell aging is largely unexplored. We determined that ex-vivo-cultured mouse and human hematopoietic stem cells (HSCs) rapidly increase protein synthesis. This challenge to HSC proteostasis was associated with nuclear accumulation of Hsf1, and deletion of Hsf1 impaired HSC maintenance ex vivo. Strikingly, supplementing cultures with small molecules that enhance Hsf1 activation partially suppressed protein synthesis, rebalanced proteostasis, and supported retention of HSC serial reconstituting activity. Although Hsf1 was dispensable for young adult HSCs in vivo, Hsf1 deficiency increased protein synthesis and impaired the reconstituting activity of middle-aged HSCs. Hsf1 thus promotes proteostasis and the regenerative activity of HSCs in response to culture stress and aging.
    Keywords:  Hsf1; aging; heat shock response; hematopoiesis; hematopoietic stem cell; protein synthesis; proteostasis; stem cell; stress; translation
    DOI:  https://doi.org/10.1016/j.stem.2021.07.009
  13. Blood. 2021 Aug 09. pii: blood.2020010419. [Epub ahead of print]
    Dopamine signaling regulates hematopoietic stem and progenitor cell function.
    Yang Liu, Qi Chen, Dong Han, Hans Schoeler, Jörg Fabian, Martin Stehling, Hyun-Woo Jeong, Hannes C A Drexler, Ralf H Adams.
      Hematopoietic stem and progenitor cell (HSPC) function in bone marrow (BM) is controlled by stroma-derived signals, but the identity and interplay of these signals remain incompletely understood. Here, we show that sympathetic nerve-derived dopamine directly controls HSPC behavior through D2-subfamily dopamine receptors. Blockade of dopamine synthesis as well as pharmacological or genetic inactivation of D2-subfamily dopamine receptors lead to reduced HSPC frequency, inhibition of proliferation and low BM transplantation efficiency. Conversely, treatment with a D2-type receptor agonist increases BM regeneration and transplantation efficiency. Mechanistically, dopamine controls expression of the kinase Lck, which, in turn, regulates mitogen-activated protein kinase-mediated signaling triggered by stem cell factor in HSPCs. Our work reveals critical functional roles of dopamine in HSPCs, which may open up new therapeutic options for improved BM transplantation and other conditions requiring the rapid expansion of HSPCs.
    DOI:  https://doi.org/10.1182/blood.2020010419
  14. Clin Lymphoma Myeloma Leuk. 2021 Jul 15. pii: S2152-2650(21)00279-2. [Epub ahead of print]
    The Real-Life Efficacy of Fixed-Dose Hypomethylating Agents in Older Patients With Acute Myeloid Leukemia: A 10-Year Experience.
    Tarinee Rungjirajittranon, Smith Kungwankiattichai, Chutima Kunacheewa, Weerapat Owattanapanich.
       BACKGROUND: Hypomethylating agent (HMA) is one of recommended treatment for elderly patients with acute myeloid leukemia (AML); however, their high cost precludes their general use, especially in developing countries. Therefore, the fixed-dose HMAs approach was adopted to reduce the expenses. This study focuses on the clinical outcome of various treatment protocols, including intensive chemotherapy, fixed-dose HMAs, and palliative treatment in Thai elderly patients with AML. Fixed-dose HMAs include 5-azacitidine given at 100 mg per day for seven days and decitabine given at 30 mg per day for 5 days.
    PATIENTS AND METHODS: We conducted a 10-year cohort study focused on elderly AML patients aged over 60 years. The exclusion criteria were acute promyelocytic leukemia.
    RESULTS: A total of 243 AML patients were enrolled. Comparing 3 groups of treatment regimens (intensive chemotherapy, fixed-dose HMAs, and palliative treatment), the proportions of patients in each category accounted for 23.5%, 21.4%, and 55.1%, respectively. The median overall survival (OS) in each therapeutic option was 7.7, 11, and 2.5 months, respectively. From multivariate analysis, palliative treatment was significantly inferior OS comparing to the fixed-dose HMAs and intensive treatment (hazard ratio [HR]: 0.42; 95% CI, 0.29-0.60; P value <.001 and HR: 0.41; 95% CI, 0.28-0.61; P value <.001, respectively). Nevertheless, the OS outcome in patients with fixed-dose HMAs was comparable to those who received intensive treatment.
    CONCLUSION: Our study demonstrates that the fixed-dose regimen of HMAs is the reasonable treatment for these patients, and this approach is not inferior to intensive therapy. Thai Clinical Trials Registry identifier: TCTR20210514007.
    Keywords:  AML; Azacitidine; Decitabine; Elderly; HMAs; Thailand
    DOI:  https://doi.org/10.1016/j.clml.2021.07.008
  15. Leuk Lymphoma. 2021 Aug 12. 1-9
    Clinical and molecular characterization of myeloid sarcoma without medullary leukemia.
    Hussein A Abbas, Patrick K Reville, Alexis Geppner, Caitlin R Rausch, Naveen Pemmaraju, Maro Ohanian, Koji Sasaki, Gautam Borthakur, Naval Daver, Courtney DiNardo, Carlos Bueso-Ramos, Sherry Pierce, Elias Jabbour, Guillermo Garcia-Manero, Marina Konopleva, Farhad Ravandi, Hagop Kantarjian, Tapan M Kadia.
      Myeloid sarcoma (MS) in the setting of concomitant medullary AML is relatively well described, while much less is known about patients presenting with MS with <20% bone marrow blasts. We conducted a retrospective analysis of 56 patients with MS with <20% marrow blasts seen at MD Anderson between 2005 and 2020. The prevalence of MS without medullary AML was 1.4% among all newly diagnosed AML patients. The majority (75%) of patients had a single known anatomic site involved, with the skin (34%) being the most frequent. The most common histologic subtype was monocytic, and 11% of patients had a known history of an antecedent hematologic disorder. The majority of patients (70%) received frontline intensive chemotherapy induction, with 75% of those evaluable attaining complete or partial responses. The median overall survival (OS) and event-free survival (EFS) were 3.41 and 3.07 years, respectively. Patients with bone marrow blasts of ≥5% or medullary relapse had inferior outcomes, while age (>60 years) was not associated with outcomes. There was a suggestion that patients with isolated leukemia cutis may have had better outcomes compared to patients with other organ involvement, but this did not reach statistical significance. Most patients who had cytogenetic analysis had a diploid karyotype within their MS and bone marrow. RAS pathway mutations were enriched in MS at diagnosis, and at time of medullary relapse. Our study provides a large dataset summarizing the clinical and molecular analysis of patients with MS with <20% BM blasts and suggests that monitoring for medullary leukemia is important for early detection of relapse.
    Keywords:  Myeloid sarcoma; acute myeloid leukemia; cytogenetics; extramedullary; medullary; molecular
    DOI:  https://doi.org/10.1080/10428194.2021.1961235
  16. Leukemia. 2021 Aug 09.
    3-Ketodihydrosphingosine reductase maintains ER homeostasis and unfolded protein response in leukemia.
    Qiao Liu, Anthony K N Chan, Wen-Han Chang, Lu Yang, Sheela Pangeni Pokharel, Kazuya Miyashita, Nicole Mattson, Xiaobao Xu, Mingli Li, Wei Lu, Ren-Jang Lin, Shao-Yuan Wang, Chun-Wei Chen.
      Sphingolipids and their metabolic pathways have been implicated in disease development and therapeutic response; however, the detailed mechanisms remain unclear. Using a sphingolipid network focused CRISPR/Cas9 library screen, we identified an endoplasmic reticulum (ER) enzyme, 3-Ketodihydrosphingosine reductase (KDSR), to be essential for leukemia cell maintenance. Loss of KDSR led to apoptosis, cell cycle arrest, and aberrant ER structure. Transcriptomic analysis revealed the indispensable role of KDSR in maintaining the unfolded protein response (UPR) in ER. High-density CRISPR tiling scan and sphingolipid mass spectrometry pinpointed the critical role of KDSR's catalytic function in leukemia. Mechanistically, depletion of KDSR resulted in accumulated 3-ketodihydrosphingosine (KDS) and dysregulated UPR checkpoint proteins PERK, ATF6, and ATF4. Finally, our study revealed the synergism between KDSR suppression and pharmacologically induced ER-stress, underscoring a therapeutic potential of combinatorial targeting sphingolipid metabolism and ER homeostasis in leukemia treatment.
    DOI:  https://doi.org/10.1038/s41375-021-01378-z
  17. Leuk Res. 2021 Jul 26. pii: S0145-2126(21)00174-0. [Epub ahead of print]111 106673
    Measurable residual disease including AML leukemia stem cell flow evaluation of CPX-351 therapy by multi-parameter flow cytometry.
    Adriana Plesa, Christophe Roumier, Joris Gutrin, Marie-Virginie Larcher, Marie Balsat, Octavia Cadassou, Fiorenza Barraco, Gaëlle Fossard, Amandine Baudouin, Hélène Labussière, Isabelle Tigaud, Sophie Ducastelle, Sandrine Hayette, Pierre Sujobert, Maël Heiblig, Mohamed Elhamri, Xavier Thomas.
      
    DOI:  https://doi.org/10.1016/j.leukres.2021.106673
  18. Cancer Cell. 2021 Aug 09. pii: S1535-6108(21)00390-1. [Epub ahead of print]39(8): 1047-1049
    Is resistance to targeted therapy in cancer inevitable?
    Lorey K Smith, Karen E Sheppard, Grant A McArthur.
      Resistance to targeted therapies is a major challenge in cancer care and occurs via genetic and non-genetic mechanisms. In this issue of Cancer Cell, Marin-Bejar et al. demonstrate that melanomas recurrently select genetic or non-genetic resistance trajectories and that targeting neural crest stem cell-like cells prevents non-genetic, but not genetic, resistance.
    DOI:  https://doi.org/10.1016/j.ccell.2021.07.013
  19. Nature. 2021 Aug 11.
    Cycling cancer persister cells arise from lineages with distinct programs.
    Yaara Oren, Michael Tsabar, Michael S Cuoco, Liat Amir-Zilberstein, Heidie F Cabanos, Jan-Christian Hütter, Bomiao Hu, Pratiksha I Thakore, Marcin Tabaka, Charles P Fulco, William Colgan, Brandon M Cuevas, Sara A Hurvitz, Dennis J Slamon, Amy Deik, Kerry A Pierce, Clary Clish, Aaron N Hata, Elma Zaganjor, Galit Lahav, Katerina Politi, Joan S Brugge, Aviv Regev.
      Non-genetic mechanisms have recently emerged as important drivers of cancer therapy failure1, where some cancer cells can enter a reversible drug-tolerant persister state in response to treatment2. Although most cancer persisters remain arrested in the presence of the drug, a rare subset can re-enter the cell cycle under constitutive drug treatment. Little is known about the non-genetic mechanisms that enable cancer persisters to maintain proliferative capacity in the presence of drugs. To study this rare, transiently resistant, proliferative persister population, we developed Watermelon, a high-complexity expressed barcode lentiviral library for simultaneous tracing of each cell's clonal origin and proliferative and transcriptional states. Here we show that cycling and non-cycling persisters arise from different cell lineages with distinct transcriptional and metabolic programs. Upregulation of antioxidant gene programs and a metabolic shift to fatty acid oxidation are associated with persister proliferative capacity across multiple cancer types. Impeding oxidative stress or metabolic reprogramming alters the fraction of cycling persisters. In human tumours, programs associated with cycling persisters are induced in minimal residual disease in response to multiple targeted therapies. The Watermelon system enabled the identification of rare persister lineages that are preferentially poised to proliferate under drug pressure, thus exposing new vulnerabilities that can be targeted to delay or even prevent disease recurrence.
    DOI:  https://doi.org/10.1038/s41586-021-03796-6
  20. Blood. 2021 Aug 13. pii: blood.2021011314. [Epub ahead of print]
    Comprehensive RNA editome reveals that edited Azin1 partners with DDX1 to enable hematopoietic stem cell differentiation.
    Fengjiao Wang, Jiahuan He, Siqi Liu, Ai Gao, Liu Yang, Guohuan Sun, Wanqiu Ding, Chuan-Yun Li, Fanglin Gou, Manman He, Fang Wang, Xiaoshuang Wang, Xiangnan Zhao, Ping Zhu, Sha Hao, Yanni Ma, Hui Cheng, Jia Yu, Tao Cheng.
      Adenosine-to-inosine (A-to-I) RNA editing and the catalyzing enzyme adenosine deaminase are both essential for hematopoietic development and differentiation. However, the RNA editome during hematopoiesis and the underlying mechanisms are poorly defined. Here, we sorted 12 murine adult hematopoietic cell populations at different stages and identified 30,796 editing sites through RNA sequencing. While the dynamic landscape of the RNA editome comprised of stage/group-specific and stable editing patterns, but also undergoing significant changes during lineage commitment. Notably, we found that antizyme inhibitor 1 (Azin1) was highly edited in hematopoietic stem and progenitor cells (HSPCs). Azin1 editing results in: (i) an amino acid change to induce Azin1 protein (AZI) translocation to the nucleus, (ii) enhanced AZI binding affinity for DEAD box polypeptide 1 (DDX1) to alter the chromatin distribution of the latter, and (iii) altered expression of multiple hematopoietic regulators which ultimately promotes HSPC differentiation. Our findings have delineated an essential role for Azin1 RNA editing in hematopoietic cells, and our dataset constitutes a valuable resource for further study of RNA editing on a more general basis.
    DOI:  https://doi.org/10.1182/blood.2021011314
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