bims-tremyl Biomed News
on Therapy resistance biology in myeloid leukemia
Issue of 2022‒07‒17
twenty papers selected by
Paolo Gallipoli
Barts Cancer Institute, Queen Mary University of London
  1. PU.1-dependent enhancer inhibition separates Tet2-deficient hematopoiesis from malignant transformation.
  2. Eprenetapopt Plus Azacitidine After Allogeneic Hematopoietic Stem-Cell Transplantation for TP53-Mutant Acute Myeloid Leukemia and Myelodysplastic Syndromes.
  3. Targeting stem cells in myelodysplastic syndromes and acute myeloid leukemia.
  4. Genome-wide analyses of 200,453 individuals yield new insights into the causes and consequences of clonal hematopoiesis.
  5. Measurable residual disease (MRD) status before allogeneic hematopoietic cell transplantation impact on secondary acute myeloid leukemia outcome. A Study from the Acute Leukemia Working Party (ALWP) of the European society for Blood and Marrow Transplantation (EBMT).
  6. Improved outcomes with 7+3 induction chemotherapy for acute myeloid leukemia over the past four decades: analysis of SWOG trial data.
  7. Mutational landscape and clinical outcome of pediatric acute myeloid leukemia with 11q23/KMT2A rearrangements.
  8. Comparison of outcomes after unrelated double-unit cord blood and haploidentical peripheral blood stem cell transplantation in adults with acute myeloid leukemia, a study on behalf of Eurocord and ALWP-EBMT.
  9. Combination of midostaurin and ATRA exerts dose-dependent dual effects on acute myeloid leukemia cells with wild type FLT3.
  10. Epigenetic regulator genes direct lineage switching in MLL/AF4 leukaemia.
  11. JOSD2 regulates PKM2 nuclear translocation and reduces acute myeloid leukemia progression.
  12. The Molecular Mechanisms of Resistance to IDH Inhibitors in Acute Myeloid Leukemia.
  13. A scoring system for AML patients aged 70 years or older, eligible for intensive chemotherapy: a study based on a large European data set using the DATAML, SAL, and PETHEMA registries.
  14. Clonal Hematopoiesis Is Not Significantly Associated with Covid-19 Disease Severity.
  15. Outcomes of Allogeneic Hematopoietic Cell Transplantation in Adults with Fusions Associated with Ph-like ALL.
  16. Ultra-sensitive monitoring of leukemia patients using superRCA mutation detection assays.
  17. Amplified EPOR/JAK2 genes define a unique subtype of acute erythroid leukemia.
  18. Allosteric Enhancement of the BCR-Abl1 Kinase Inhibition Activity of Nilotinib by Co-Binding of Asciminib.
  19. The surfaceome of multiple myeloma cells suggests potential immunotherapeutic strategies and protein markers of drug resistance.
  20. Acetyl-CoA-Carboxylase 1-mediated de novo fatty acid synthesis sustains Lgr5+ intestinal stem cell function.
  1. Blood Cancer Discov. 2022 Aug 01. pii: bcd.21.0226. [Epub ahead of print]
    PU.1-dependent enhancer inhibition separates Tet2-deficient hematopoiesis from malignant transformation.
    Maria M Aivalioti, Boris A Bartholdy, Kith Pradhan, Tushar D Bhagat, Aliona Zintiridou, Jong Jin Jeong, Victor J Thiruthuvanathan, Mario Pujato, Aditi Paranjpe, Chi Zhang, Ross L Levine, Aaron D Viny, Amittha Wickrema, Amit Verma, Britta Will.
      Cytosine hypermethylation in and around DNA binding sites of master transcription factors, including PU.1, occurs in aging hematopoietic stem cells following acquired loss-of-function mutations of DNA methyl-cytosine dioxygenase Ten-Eleven Translocation-2 (TET2), albeit functional relevance has been unclear. We show that Tet2 deficient mouse hematopoietic stem and progenitor cells undergo malignant transformation upon compromised gene regulation through heterozygous deletion of an upstream regulatory region (UREd/WT) of the PU.1 gene. While compatible with multilineage blood formation at young age, Tet2 deficient PU.1 UREd/WT mice develop highly penetrant, transplantable acute myeloid leukemia (AML) during aging. Leukemic stem and progenitor cells show hypermethylation at putative PU.1 binding sites, fail to activate myeloid enhancers, and are hallmarked by a signature of genes with impaired expression shared with human AML. Our study demonstrates that Tet2 and PU.1 jointly suppress leukemogenesis and uncovered a methylation sensitive PU.1-dependent gene network as a unifying molecular vulnerability associated with AML.
    DOI:  https://doi.org/10.1158/2643-3230.BCD-21-0226
  2. J Clin Oncol. 2022 Jul 11. JCO2200181
    Eprenetapopt Plus Azacitidine After Allogeneic Hematopoietic Stem-Cell Transplantation for TP53-Mutant Acute Myeloid Leukemia and Myelodysplastic Syndromes.
    Asmita Mishra, Roni Tamari, Amy E DeZern, Michael T Byrne, Mahasweta Gooptu, Yi-Bin Chen, H Joachim Deeg, David Sallman, Phillip Gallacher, Anders Wennborg, Denice K Hickman, Eyal C Attar, Hugo F Fernandez.
      PURPOSE: Outcomes are poor in TP53-mutant (mTP53) acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS), even after allogeneic hematopoietic stem-cell transplant (HCT). Eprenetapopt (APR-246) is a first-in-class, small-molecule p53 reactivator.PATIENTS AND METHODS: We conducted a phase II, multicenter, open-label trial to assess efficacy and safety of eprenetapopt combined with azacitidine as maintenance therapy after HCT (ClinicalTrials.gov identifier: NCT03931291). Patients with mTP53 MDS or AML received up to 12 cycles of eprenetapopt 3.7 g once daily intravenously on days 1-4 and azacitidine 36 mg/m2 once daily intravenously/subcutaneously on days 1-5 in 28-day cycles. The primary outcomes were relapse-free survival (RFS) and safety.
    RESULTS: Of the 84 patients screened for eligibility before HCT, 55 received a transplant. Thirty-three patients ultimately received maintenance treatment (14 AML and 19 MDS); the median age was 65 (range 40-74) years. The median number of eprenetapopt cycles was 7 (range 1-12). With a median follow-up of 14.5 months, the median RFS was 12.5 months (95% CI, 9.6 to not estimable) and the 1-year RFS probability was 59.9% (95% CI, 41 to 74). With a median follow-up of 17.0 months, the median overall survival (OS) was 20.6 months (95% CI, 14.2 to not estimable) and the 1-year OS probability was 78.8% (95% CI, 60.6 to 89.3). Thirty-day and 60-day mortalities from the first dose were 0% and 6% (n = 2), respectively. Acute and chronic (all grade) graft-versus-host disease adverse events were reported in 12% (n = 4) and 33% (n = 11) of patients, respectively.
    CONCLUSION: In patients with mTP53 AML and MDS, post-HCT maintenance therapy with eprenetapopt combined with azacitidine was well tolerated. RFS and OS outcomes were encouraging in this high-risk population.
    DOI:  https://doi.org/10.1200/JCO.22.00181
  3. J Intern Med. 2022 Jul 13.
    Targeting stem cells in myelodysplastic syndromes and acute myeloid leukemia.
    Petter S Woll, Tetsuichi Yoshizato, Eva Hellström-Lindberg, Thoas Fioretos, Benjamin L Ebert, Sten Eirik W Jacobsen.
      The genetic architecture of cancer has been delineated through advances in high-throughput next-generation sequencing, where the sequential acquisition of recurrent driver mutations initially targeted towards normal cells ultimately leads to malignant transformation. Myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) are hematologic malignancies frequently initiated by mutations in the normal hematopoietic stem cell compartment leading to the establishment of leukemic stem cells. Although the genetic characterization of MDS and AML has led to identification of new therapeutic targets and development of new promising therapeutic strategies, disease progression, relapse, and treatment-related mortality remain a major challenge in MDS and AML. The selective persistence of rare leukemic stem cells following therapy-induced remission implies unique resistance mechanisms of leukemic stem cells towards conventional therapeutic strategies and that leukemic stem cells represent the cellular origin of relapse. Therefore, targeted surveillance of leukemic stem cells following therapy should, in the future, allow better prediction of relapse and disease progression, but is currently challenged by our restricted ability to distinguish leukemic stem cells from other leukemic cells and residual normal cells. To advance current and new clinical strategies for the treatment of MDS and AML, there is a need to improve our understanding and characterization of MDS and AML stem cells at the cellular, molecular, and genetic levels. Such work has already led to the identification of promising new candidate leukemic stem cell molecular targets that can now be exploited in preclinical and clinical therapeutic strategies, towards more efficient and specific elimination of leukemic stem cells.
    Keywords:  acute myeloid leukemia; clonal evolution; hematopoietic stem cells; leukemic stem cells; myelodysplastic syndromes; therapeutic targets
    DOI:  https://doi.org/10.1111/joim.13535
  4. Nat Genet. 2022 Jul 14.
    Genome-wide analyses of 200,453 individuals yield new insights into the causes and consequences of clonal hematopoiesis.
    Siddhartha P Kar, Pedro M Quiros, Muxin Gu, Tao Jiang, Jonathan Mitchell, Ryan Langdon, Vivek Iyer, Clea Barcena, M S Vijayabaskar, Margarete A Fabre, Paul Carter, Slavé Petrovski, Stephen Burgess, George S Vassiliou.
      Clonal hematopoiesis (CH), the clonal expansion of a blood stem cell and its progeny driven by somatic driver mutations, affects over a third of people, yet remains poorly understood. Here we analyze genetic data from 200,453 UK Biobank participants to map the landscape of inherited predisposition to CH, increasing the number of germline associations with CH in European-ancestry populations from 4 to 14. Genes at new loci implicate DNA damage repair (PARP1, ATM, CHEK2), hematopoietic stem cell migration/homing (CD164) and myeloid oncogenesis (SETBP1). Several associations were CH-subtype-specific including variants at TCL1A and CD164 that had opposite associations with DNMT3A- versus TET2-mutant CH, the two most common CH subtypes, proposing key roles for these two loci in CH development. Mendelian randomization analyses showed that smoking and longer leukocyte telomere length are causal risk factors for CH and that genetic predisposition to CH increases risks of myeloproliferative neoplasia, nonhematological malignancies, atrial fibrillation and blood epigenetic ageing.
    DOI:  https://doi.org/10.1038/s41588-022-01121-z
  5. Bone Marrow Transplant. 2022 Jul 14.
    Measurable residual disease (MRD) status before allogeneic hematopoietic cell transplantation impact on secondary acute myeloid leukemia outcome. A Study from the Acute Leukemia Working Party (ALWP) of the European society for Blood and Marrow Transplantation (EBMT).
    Enrico Maffini, Myriam Labopin, Dietrich Wilhelm Beelen, Nicolaus Kroeger, Mutlu Arat, Keith M O Wilson, Jacques-Olivier Bay, Arnold Ganser, Hans Martin, Jakob Passweg, Panagiotis D Kottaridis, Ibrahim Yakoub-Agha, Rocio Parody Porras, Eva Maria Wagner, Jordi Esteve, Francesco Lanza, Arnon Nagler, Mohamad Mohty.
      Measurable residual disease (MRD) assessment before allogeneic hematopoietic cell transplantation (HCT) may help physicians to identify a subgroup of patients at high risk of relapse for de novo acute myeloid leukemia (AML) but its relevance among patients affected by secondary AML (sAML) is still unknown. We assessed the impact of MRD among 318 adult patients with sAML who received an allogeneic HCT in first complete remission. At the time of HCT, a total of 208 (65%) patients achieved MRD negativity, while 110 (35%) had positive MRD. 2-year overall survival (OS) was 58.8 % (95% CI 52.2-64.9) with leukemia-free survival (LFS) of 50.0 % (95% CI 43.7-56.1), relapse incidence of 34.2% (95% CI 28.4-40.1) and non-relapse mortality (NRM) of 23.3 % (95% CI 19-27.7) for the entire cohort. In multivariate analysis, HCT recipients with KPS ≥ 90 experienced less disease recurrence (HR 0.61, 95% CI 0.4-0.94) with better LFS (HR 0.63, 95% CI 0.44-0.89) and OS (HR 0.58, 95% CI 0.39-0.86). There were no differences in major clinical endpoints between patients with MRD-positive and MRD-negative status at the time of HCT. Pre-transplantation assessment of MRD was not informative on post-HCT outcomes in this retrospective registry-based analysis among patients affected by sAML.
    DOI:  https://doi.org/10.1038/s41409-022-01748-w
  6. Haematologica. 2022 Jul 14.
    Improved outcomes with 7+3 induction chemotherapy for acute myeloid leukemia over the past four decades: analysis of SWOG trial data.
    Megan Othus, Guillermo Garcia-Manero, John E Godwin, James K Weick, Frederick R Appelbaum, Harry P Erba, Elihu H Estey.
      We have previously shown that complete response (CR) rates and overall survival (OS) of patients with acute myeloid leukemia (AML) have improved since the 1980s. However, we have not previously evaluated how the length of first CR (CR1) has changed over this time period. To address this, we analyzed 1,247 patients age 65 or younger randomized to 7+3 arms from 5 SWOG studies: S8600 (n=530), S9031 (n=98), S9333 (n=57), S0106 (n=301), S1203 (n=261). We evaluated length of CR1 and survival after relapse from CR1 over the 4 decades these studies represent. Both length of CR1 and survival after relapse from CR1 have improved over the last four decades. The relative benefit associated with CR1 and the relative detriment associated with relapse have decreased over this period; while achieving CR1 and relapse from CR1 still have strong prognostic associations with outcomes, the magnitude of the association has decreased over time. Possible explanations for these patterns include higher CR rates with salvage therapies after relapse, more frequent use of hematopoietic cell transplant, and better supportive care.
    DOI:  https://doi.org/10.3324/haematol.2022.280765
  7. Cancer Med. 2022 Jul 14.
    Mutational landscape and clinical outcome of pediatric acute myeloid leukemia with 11q23/KMT2A rearrangements.
    Ka-Yuk Yuen, Yong Liu, Yong-Zhuo Zhou, Yin Wang, Dun-Hua Zhou, Jian-Pei Fang, Lu-Hong Xu.
      BACKGROUND: Alterations of 11q23/KMT2A are the most prevalent cytogenetic abnormalities in acute myeloid leukemia (AML) and the prognostic significance of 11q23/KMT2A-rearranged AML based on various translocation partners varies among different studies. However, few studies evaluated the molecular characteristics of 11q23/KMT2A-rearranged pediatric AML. We aim to analyze the mutational landscape of 11q23/KMT2A-rearranged AML and assess their prognostic value in outcomes.METHODS: The mutational landscape and clinical prognosis of 105 children with 11q23/KMT2A-rearranged AML in comparison with 277 children with non-11q23/KMT2A-rearranged AML were analyzed using publicly accessible next-generation sequencing data from Therapeutically Applicable Research to Generate Effective Treatments (TARGET) dataset.
    RESULTS: Pediatric AML patients with 11q23/KMT2A-rearrangements harbored a low number of mutations (Median, 1 mutation/patient, range, 1-22), 58% of which involved in RAS pathway mutations (KRAS, NRAS, and PTPN11) and 10.5% of which comprised of SETD2 mutations. Compared with non-11q23/KMT2A-rearranged AML, the incidence of KRAS (32.4% vs. 10.1%, P〈0.001) and SETD2 (10.5% vs. 1.4%, P=0.001) gene mutations in 11q23/KMT2A-rearranged AML was significantly higher. Both KRAS and SETD2 mutations occurred more often in t(10;11)(p12;q23). KRAS mutations were correlated with worse 5-year event-free survival [EFS] (Plog-rank = 0.001) and 5-year overall survival [OS] (Plog-rank = 0.009) and the presence of SETD2 mutations increases the 5-year relapse rate (PGray = 0.004). Multivariate analyses confirmed KRAS mutations in 11q23/KMT2A-rearranged AML as an independent predictor for poor EFS (hazard ratio [HR] = 2.10, P=0.05) and OS (HR = 2.39, P=0.054).
    CONCLUSION: Our findings show that pediatric patients with 11q23/KMT2A rearrangements have characteristic mutation patterns and varying clinical outcomes depending on different translocation partners, which could be utilized to develop more accurate risk stratification and tailored therapies.
    Keywords:  11q23/KMT2A; clinical outcome; gene mutations; pediatric acute myeloid leukemia; sequencing
    DOI:  https://doi.org/10.1002/cam4.5026
  8. Transplant Cell Ther. 2022 Jul 10. pii: S2666-6367(22)01466-X. [Epub ahead of print]
    Comparison of outcomes after unrelated double-unit cord blood and haploidentical peripheral blood stem cell transplantation in adults with acute myeloid leukemia, a study on behalf of Eurocord and ALWP-EBMT.
    Annalisa Ruggeri, Jacques-Emmanuel Galimard, Myriam Labopin, Hanadi Rafii, Didier Blaise, Fabio Ciceri, Jose-Luiz Diez-Martin, Jan Cornelissen, Patrice Chevallier, Fermin Sanchez-Guijo, Emma Nicholson, Luca Castagna, Edouard Forcade, Jürgen Kuball, Montserrat Rovira, Yener Koc, Jiri Pavlu, Zafar Gulbas, Jan Vydra, Frederic Baron, Jaime Sanz, Alexandros Spyridonidis, Bipin Savani, Eliane Gluckman, Arnon Nagler, Mohamad Mohty.
      BACKGROUND: Unmanipulated haploidentical stem cell transplantation with post-transplant cyclophosphamide as graft-versus-host disease (GVHD) prophylaxis (Haplo-PTCY) and unrelated double-unit umbilical cord blood transplant (dUCBT) are feasible options to treat patients with high risk acute myeloid leukemia (AML).OBJECTIVES: The aim of our study was to compare outcomes after dUCBT and Haplo-HCT using PBSC in adult patients with AML in complete remission (CR) transplanted in European Society for Blood and Marrow Transplantation (EBMT) affiliated centers.
    STUDY DESIGN: In a population of adults with de novo AML in first or second CR, we compared outcomes after dUCBT (n=165) and after Haplo-PTCY PBSC (n=544) performed between January 2013 and December 2018. Patients receiving in-vivo antithymocyte globuline (ATG), Campath, or ex-vivo T-cell depletion were excluded.
    RESULTS: Median follow-up was 33 months for Haplo-PTCY and 52 months for dUCBT. No statically significant differences were observed between the two approaches in grade-II-IV acute-GVHD (hazard ratio [HR]=1.31, p=0.18), and grade-III-IV (HR=1.17, p=0.56) or in chronic-GVHD (HR=0.86, p=0.48) or relapse (HR=1.07, p=0.77), non-relapse mortality (NRM; HR=0.94, p=0.77), leukemia-free survival (LFS; HR=0.99, p=0.95) and overall survival (OS; HR=0.99, p=0.97) when comparing dUCBT with Haplo-PTCY. Favourable cytogenetic risk was the only factor predictive of lower relapse incidence. Younger age at transplant was associated with lower NRM and higher LFS and OS.
    CONCLUSION: Both dUCBT and Haplo-PTCY with PBSC can be considered as valid approaches for adult AML patients in complete remission. New strategies should be investigated in both settings to define the most appropriate conditioning regimen and potentially, to decrease relapse incidence and NRM through better immune reconstitution and optimal supportive care.
    Keywords:  acute myeloid leukemia; double cord blood transplantation; haploidentical transplant; posttransplant cyclophosphamide
    DOI:  https://doi.org/10.1016/j.jtct.2022.07.006
  9. BMC Cancer. 2022 Jul 09. 22(1): 749
    Combination of midostaurin and ATRA exerts dose-dependent dual effects on acute myeloid leukemia cells with wild type FLT3.
    Hao Lu, Xiang-Qin Weng, Yan Sheng, Jing Wu, Hui-Min Xi, Xun Cai.
      BACKGROUND: Midostaurin combined with chemotherapy is currently used to treat newly diagnosed acute myeloid leukemia (AML) patients with FMS-like tyrosine kinase 3 (FLT3)-mutations. However, midostaurin acts as an antagonist to some chemotherapeutic agents in leukemia cell lines without FLT3 mutations. All-trans retinoic acid (ATRA) induces apoptosis when used in combination with midostaurin in FLT3-mutated AML cells. This combination has been shown to be safe in AML patients. However, the effect of this combination has not been investigated in AML without FLT3 mutations.METHODS: Cell proliferation was assessed by a cell counting assay. Cell death was evaluated by cell viability and Annexin-V assays. Cell differentiation was assessed by CD11b expression profiling and morphological analysis. To explore the underlying mechanisms, we studied the role of caspase3/7, Lyn, Fgr, Hck, RAF, MEK, ERK, AKT, PU.1, CCAAT/enhancer binding protein β (C/EBPβ) and C/EBPε by Western blot analysis and immunoprecipitation assays. Antitumor activity was also confirmed in mouse xenograft models established with AML cells.
    RESULTS: In this study, 0.1 - 0.25 μM midostaurin (mido(L)) combined with ATRA induced differentiation while 0.25 - 0.5 μM midostaurin (mido(H)) combined with ATRA triggered apoptosis in some AML cell lines without FLT3-mutations. Midostaurin combined with ATRA (mido-ATRA) also exhibited antitumor activity in mouse xenograft models established with AML cells. Mechanistically, mido(H)-ATRA-induced apoptosis was dependent on caspase-3/7. Mido(L)-ATRA inhibited Akt activation which was associated with decreased activity of Lyn/Fgr/Hck, resulted in dephosphorylation of RAF S259, activated RAF/MEK/ERK, along with upregulating the protein levels of C/EBPβ, C/EBPε and PU.1. A MEK specific inhibitor was observed to suppress mido(L)-ATRA-induced increases in the protein levels of C/EBPs and PU.1 and mido(L)-ATRA-induced differentiation. Furthermore, inhibition of Akt activity promoted mido(L)-ATRA-induced downregulation of RAF S259 phosphorylation and mido(L)-ATRA-induced differentiation. Therefore, Lyn/Fgr/Hck-associated Akt inhibition activated RAF/MEK/ERK and controlled mido(L)-ATRA-induced differentiation by upregulation of C/EBPs and PU.1. Mido(L)-ATRA also promoted assembly of the signalosome, which may facilitate RAF activation.
    CONCLUSIONS: Midostaurin combined with ATRA exerts antitumor activity against AML with wild-type FLT3 mutations in vitro and in vivo. These findings may provide novel therapeutic strategies for some AML patients without FLT3 mutations and imply a new target of midostaurin.
    Keywords:  Acute myeloid leukemia; All-trans retinoic acid; Apoptosis; Differentiation; Midostaurin
    DOI:  https://doi.org/10.1186/s12885-022-09828-2
  10. Blood. 2022 Jul 15. pii: blood.2021015036. [Epub ahead of print]
    Epigenetic regulator genes direct lineage switching in MLL/AF4 leukaemia.
    Ricky Tirtakusuma, Katarzyna Szoltysek, Paul Milne, Vasily Grinev, Anetta Ptasinska, Paulynn Suyin Chin, Claus Meyer, Sirintra Nakjang, Jayne Y Hehir-Kwa, Daniel Williamson, Pierre Cauchy, Peter Keane, Salam A Assi, Minoo Ashtiani, Sophie G Kellaway, Maria R Imperato, Fotini Vogiatzi, Elizabeth K Schweighart-James, Shan Lin, Mark Wunderlich, Janine Stutterheim, Alexander Komkov, Elena Zerkalenkova, Paul Evans, Hesta Varey McNeill, Alex Elder, Natalia Martínez-Soria, Sarah E Fordham, Yuzhe Shi, Lisa J Russell, Deepali Pal, Alexandra G Smith, Zoya Kingsbury, Jennifer Becq, Cornelia Eckert, Oskar A Haas, Peter Carey, Simon Bailey, Roderick Skinner, Natalia Miakova, Matthew Collin, Venetia Bigley, Muzlifah Haniffa, Rolf Marschalek, Christine J Harrison, Catherine A Cargo, Denis Martin Schewe, Yulia Olshanskaya, Michael J Thirman, Peter N Cockerill, James C Mulloy, Helen J Blair, H Josef Vormoor, James M Allan, Constanze Bonifer, Olaf Heidenreich, Simon N Bomken.
      The fusion gene MLL/AF4 defines a high-risk subtype of pro-B acute lymphoblastic leukaemia. Relapse can be associated with a lineage switch from acute lymphoblastic to acute myeloid leukaemia resulting in poor clinical outcomes due to resistance towards chemo- and immuno-therapies. Here we show that the myeloid relapses share oncogene fusion breakpoints with their matched lymphoid presentations and can originate from varying differentiation stages from immature progenitors through to committed B-cell precursors. Lineage switching is linked to substantial changes in chromatin accessibility and rewiring of transcriptional programmes, including alternative splicing. These findings indicate that the execution and maintenance of lymphoid lineage differentiation is impaired. The relapsed myeloid phenotype is recurrently associated with the altered expression, splicing or mutation of chromatin modifiers, including CHD4 coding for the ATPase/helicase of the nucleosome remodelling and deacetylation complex, NuRD. Perturbation of CHD4 alone or in combination with other mutated epigenetic modifiers induces myeloid gene expression in MLL/AF4-positive cell models indicating that lineage switching in MLL/AF4 leukaemia is driven and maintained by disrupted epigenetic regulation.
    DOI:  https://doi.org/10.1182/blood.2021015036
  11. Exp Hematol Oncol. 2022 Jul 14. 11(1): 42
    JOSD2 regulates PKM2 nuclear translocation and reduces acute myeloid leukemia progression.
    Hu Lei, Li Yang, Yingying Wang, Zhihui Zou, Meng Liu, Hanzhang Xu, Yingli Wu.
      Pyruvate kinase M2 (PKM2) plays an important role in the metabolism and proliferation of leukemia cells. Here, we show that deubiquitinase JOSD2, a novel tumor suppressor, blocks PKM2 nuclear localization by reducing its K433 acetylation in acute myeloid leukemia (AML). Firstly, we show that JOSD2 is significantly down-regulated in primary AML cells. Reconstitute of JOSD2 in AML cells significantly inhibit cell viability and induce cell apoptosis. Next, PKM2 is identified as a novel interaction protein of JOSD2 by mass spectrometry, co- immunoprecipitation and co-immunofluorescence in HL60 cells. However, JOSD2 does not affect PKM2 protein stability. We then found out that JOSD2 inhibits nuclear localization of PKM2 by reducing its K433 acetylation modification, accompanied by decreased downstream gene expression through non-glycolytic functions. Finally, JOSD2 decreases AML progression in vivo. Taken together, we propose that JOSD2 blocks PKM2 nuclear localization and reduces AML progression.
    Keywords:  Acute myeloid leukemia; JOSD2; Nuclear localization; PKM2
    DOI:  https://doi.org/10.1186/s40164-022-00295-w
  12. Front Oncol. 2022 ;12 931462
    The Molecular Mechanisms of Resistance to IDH Inhibitors in Acute Myeloid Leukemia.
    Xiaomei Zhuang, Han Zhong Pei, Tianwen Li, Junbin Huang, Yao Guo, Yuming Zhao, Ming Yang, Dengyang Zhang, Zhiguang Chang, Qi Zhang, Liuting Yu, Chunxiao He, Liqing Zhang, Yihang Pan, Chun Chen, Yun Chen.
      Gain-of-function mutations of isocitrate dehydrogenases 1/2 (IDH1/2) play crucial roles in the development and progression of acute myeloid leukemia (AML), which provide promising therapeutic targets. Two small molecular inhibitors, ivosidenib and enasidenib have been approved for the treatment of IDH1- and IDH2-mutant AML, respectively. Although these inhibitors benefit patients with AML clinically, drug resistance still occurs and have become a major problem for targeted therapies of IDH-mutant AML. A number of up-to-date studies have demonstrated molecular mechanisms of resistance, providing rationales of novel therapeutic strategies targeting mutant IDH1/2. In this review, we discuss mechanisms of resistance to ivosidenib and enasidenib in patients with AML.
    Keywords:  IDH1; IDH2; acute myeloid leukemia; cancer metabolism; drug resistance
    DOI:  https://doi.org/10.3389/fonc.2022.931462
  13. Blood Cancer J. 2022 Jul 11. 12(7): 107
    A scoring system for AML patients aged 70 years or older, eligible for intensive chemotherapy: a study based on a large European data set using the DATAML, SAL, and PETHEMA registries.
    Emilie Bérard, Christoph Röllig, Sarah Bertoli, Arnaud Pigneux, Suzanne Tavitian, Michael Kramer, Hubert Serve, Martin Bornhäuser, Uwe Platzbecker, Carsten Müller-Tidow, Claudia D Baldus, David Martínez-Cuadrón, Josefina Serrano, Pilar Martínez-Sánchez, Eduardo Rodríguez Arbolí, Cristina Gil, Juan Bergua, Teresa Bernal, Adolfo de la Fuente Burguera, Eric Delabesse, Audrey Bidet, Pierre-Yves Dumas, Pau Montesinos, Christian Récher.
      In a context of therapeutic revolution in older adults with AML, it is becoming increasingly important to select patients for the various treatment options by taking account of short-term efficacy and toxicity as well as long-term survival. Here, the data from three European registries for 1,199 AML patients aged 70 years or older treated with intensive chemotherapy were used to develop a prognostic scoring system. The median follow-up was 50.8 months. In the training set of 636 patients, age, performance status, secondary AML, leukocytosis, and cytogenetics, as well as NPM1 mutations (without FLT3-ITD), were all significantly associated with overall survival, albeit not to the same degree. These factors were used to develop a score that predicts long-term overall survival. Three risk-groups were identified: a lower, intermediate and higher-risk score with predicted 5-year overall survival (OS) probabilities of ≥12% (n = 283, 51%; median OS = 18 months), 3-12% (n = 226, 41%; median OS = 9 months) and <3% (n = 47, 8%; median OS = 3 months), respectively. This scoring system was also significantly associated with complete remission, early death and relapse-free survival; performed similarly in the external validation cohort (n = 563) and showed a lower false-positive rate than previously published scores. The European Scoring System ≥70, easy for routine calculation, predicts long-term survival in older AML patients considered for intensive chemotherapy.
    DOI:  https://doi.org/10.1038/s41408-022-00700-x
  14. Blood. 2022 Jul 15. pii: blood.2022015721. [Epub ahead of print]
    Clonal Hematopoiesis Is Not Significantly Associated with Covid-19 Disease Severity.
    Yifan Zhou, Ruba N Shalhoub, Stephanie N Rogers, Shiqin Yu, Muxin Gu, Margarete Alice Fabre, Pedro M Quiros, Arch Diangson, Wenhan Deng, Shubha Anand, Wanhua Lu, Matthew Cullen, Anna L Godfrey, Jacobus Preller, Jérôme Hadjadj, Emmanuelle Jouanguy, Aurélie Cobat, Laurent Abel, Frédéric Rieux-Laucat, Benjamin Terrier, Alain Fischer, Laura Novik, Ingelise J Gordon, Larisa Strom, Martin Gaudinski, Andrea Lisco, Irini Sereti, Thomas J Gniadek, Andrea Biondi, Paolo Bonfanti, Luisa Imberti, Yu Zhang, Clifton L Dalgard, Kerry Dobbs, Helen C Su, Luigi D Notarangelo, Colin O Wu, Peter J M Openshaw, Malcolm Gracie Semple, Ziad Mallat, Kenneth Baillie, Cynthia E Dunbar, George S Vassiliou.
      
    DOI:  https://doi.org/10.1182/blood.2022015721
  15. Blood Adv. 2022 Jul 11. pii: bloodadvances.2022007597. [Epub ahead of print]
    Outcomes of Allogeneic Hematopoietic Cell Transplantation in Adults with Fusions Associated with Ph-like ALL.
    Ibrahim Aldoss, Dongyun Yang, Vanina Tomasian, Sally Mokhtari, Ryan Jackson, Zhaohui Gu, Milhan Telatar, Hooi Yew, Monzr M Al Malki, Amandeep Salhotra, Samer Khaled, Haris Ali, Ahmed Aribi, Karamjeet Singh Sandhu, Matthew G Mei, Shukaib Arslan, Paul B Koller, Andrew S Artz, Patricia Aoun, Dongqing Gu, David S Snyder, Forrest Stewart, Peter Thomas Curtin, Anthony S Stein, Raju K Pillai, Guido Marcucci, Stephen J Forman, Vinod A Pullarkat, Ryotaro Nakamura, Michelle Afkhami.
      Allogenic hematopoietic cell transplantation (alloHCT) is a well-established curative modality for adults with high-risk ALL; yet large data describing alloHCT outcomes in Philadelphia (Ph)-like ALL is lacking. We retrospectively analyzed archived DNA samples from consecutive adults with B-cell Ph-negative ALL who underwent alloHCT in complete remission (CR) (n= 127) at our center between 2006 and 2020. Identification of fusions associated with Ph-like were performed using accumulative results from RNAseq, conventional cytogenetics, FISH, and whole genome array studies. Fusions associated with Ph-like were detected in 56 (44%) patients, of whom 38 were carrying CRLF2r; and the rest (n=18) were non-CRLF2r. Compared to other non-Ph-like (n=71), patients with fusions associated with Ph-like ALL were more frequently Hispanic (P=0.008), less frequently carried high-risk cytogenetics (P<0.001), and more likely to receive blinatumomab prior to HCT (P=0.019). With the median follow-up of 3.5 years, patients with Ph-like ALL fusions had comparable post-transplant outcomes compared to other B-cell ALL: 3-year relapse-free survival (RFS) [41% vs. 44%, P=0.36], overall survival (OS) [51% vs. 50%, P=0.59] and relapse [37% vs. 31%, P=0.47]. In multivariable analysis, age (P= 0.023), disease status at the time of transplant (P<0.001), and donor type (P=0.015) influenced OS. RFS (primary endpoint) was significantly influenced by disease status (P<0.001) and conditioning regimen intensity (P=0.014). Relapse rate was associated with disease status (P=0.028) and conditioning regimen intensity (P=0.028). In conclusion, our data suggest that alloHCT consolidation results in similarly favorable survival outcomes in adult patients with Ph-like fusions and other high-risk B-cell ALL.
    DOI:  https://doi.org/10.1182/bloodadvances.2022007597
  16. Nat Commun. 2022 Jul 12. 13(1): 4033
    Ultra-sensitive monitoring of leukemia patients using superRCA mutation detection assays.
    Lei Chen, Anna Eriksson, Simone Weström, Tatjana Pandzic, Sören Lehmann, Lucia Cavelier, Ulf Landegren.
      Rare tumor-specific mutations in patient samples serve as excellent markers to monitor the course of malignant disease and responses to therapy in clinical routine, and improved assay techniques are needed for broad adoption. We describe herein a highly sensitive and selective molecule amplification technology - superRCA assays - for rapid and highly specific detection of DNA sequence variants present at very low frequencies in DNA samples. Using a standard flow cytometer we demonstrate precise, ultra-sensitive detection of single-nucleotide mutant sequences from malignant cells against up to a 100,000-fold excess of DNA from normal cells in either bone marrow or peripheral blood, to follow the course of patients treated for acute myeloid leukemia (AML). We also demonstrate that sequence variants located in a high-GC region may be sensitively detected, and we illustrate the potential of the technology for early detection of disease recurrence as a basis for prompt change of therapy.
    DOI:  https://doi.org/10.1038/s41467-022-31397-y
  17. Blood Cancer Discov. 2022 Jul 15. pii: bcd.21.0192. [Epub ahead of print]
    Amplified EPOR/JAK2 genes define a unique subtype of acute erythroid leukemia.
    June Takeda, Kenichi Yoshida, Masahiro M Nakagawa, Yasuhito Nannya, Akinori Yoda, Ryunosuke Saiki, Yotaro Ochi, Lanying Zhao, Rurika Okuda, Xingxing Qi, Takuto Mori, Ayana Kon, Kenichi Chiba, Hiroko Tanaka, Yuichi Shiraishi, Ming-Chung Kuo, Cassandra M Kerr, Yasunobu Nagata, Daisuke Morishita, Nobuhiro Hiramoto, Akira Hangaishi, Hideyuki Nakazawa, Ken Ishiyama, Satoru Miyano, Shigeru Chiba, Yasushi Miyazaki, Toshiyuki Kitano, Kensuke Usuki, Nobuo Sezaki, Hisashi Tsurumi, Shuichi Miyawaki, Jaroslaw P Maciejewski, Takayuki Ishikawa, Kazuma Ohyashiki, Arnold Ganser, Michael Heuser, Felicitas Thol, Lee-Yung Shih, Akifumi Takaori-Kondo, Hideki Makishima, Seishi Ogawa.
      Acute erythroid leukemia (AEL) is a unique subtype of acute myeloid leukemia characterized by prominent erythroid proliferation whose molecular basis is poorly understood. To elucidate the underlying mechanism of erythroid proliferation, we analyzed 121 AEL using whole-genome/exome and/or targeted-capture sequencing, together with transcriptome analysis of 21 AEL samples. Combining publicly available sequencing data, we found a high frequency of gains/amplifications involving EPOR/JAK2 in TP53-mutated cases, particularly those having >80% erythroblasts designated as pure erythroid leukemia (10/13). These cases were frequently accompanied by gains/amplifications of ERG/ETS2 and associated with a very poor prognosis, even compared with other TP53-mutated AEL. In addition to activation of the STAT5 pathway, a common feature across all AEL cases, these AEL cases exhibited enhanced cell proliferation and heme metabolism and often showed high sensitivity to ruxolitinib in vitro and in xenograft models, highlighting a potential role of JAK2 inhibition in therapeutics of AEL.
    DOI:  https://doi.org/10.1158/2643-3230.BCD-21-0192
  18. J Biol Chem. 2022 Jul 06. pii: S0021-9258(22)00680-9. [Epub ahead of print] 102238
    Allosteric Enhancement of the BCR-Abl1 Kinase Inhibition Activity of Nilotinib by Co-Binding of Asciminib.
    Baswanth Oruganti, Erik Lindahl, Jingmei Yang, Wahid Amiri, Rezwan Rahimullah, Ran Friedman.
      Inhibitors that bind competitively to the ATP binding pocket in the kinase domain of the oncogenic fusion protein BCR-Abl1 are used successfully in targeted therapy of chronic myeloid leukemia (CML). Such inhibitors provided the first proof of concept that kinase inhibition can succeed in a clinical setting. However, emergence of drug resistance and dose-dependent toxicities limit the effectiveness of these drugs. Therefore, treatment with a combination of drugs without overlapping resistance mechanisms appears to be an appropriate strategy. In the present work, we explore the effectiveness of combination therapies of the recently developed allosteric inhibitor asciminib with the ATP-competitive inhibitors nilotinib and dasatinib in inhibiting the BCR-Abl1 kinase activity in CML cell lines. Through these experiments, we demonstrate that asciminib significantly enhances the inhibition activity of nilotinib, but not of dasatinib. Exploring molecular mechanisms for such allosteric enhancement via systematic computational investigation incorporating molecular dynamics, metadynamics simulations, and density functional theory (DFT) calculations, we found two distinct contributions. First, binding of asciminib triggers conformational changes in the inactive state of the protein, thereby making the activation process less favorable by ∼4 kcal/mol. Second, the binding of asciminib decreases the binding free energies of nilotinib by ∼3 and ∼7 kcal/mol for the wild-type and T315I-mutated protein, respectively, suggesting the possibility of reducing nilotinib dosage and lowering risk of developing resistance in the treatment of CML.
    Keywords:  Allosteric Inhibition; BCR-Abl1 Kinase; Combination Therapy; Drug Resistance; Tyrosine Kinase Inhibitors
    DOI:  https://doi.org/10.1016/j.jbc.2022.102238
  19. Nat Commun. 2022 Jul 15. 13(1): 4121
    The surfaceome of multiple myeloma cells suggests potential immunotherapeutic strategies and protein markers of drug resistance.
    Ian D Ferguson, Bonell Patiño-Escobar, Sami T Tuomivaara, Yu-Hsiu T Lin, Matthew A Nix, Kevin K Leung, Corynn Kasap, Emilio Ramos, Wilson Nieves Vasquez, Alexis Talbot, Martina Hale, Akul Naik, Audrey Kishishita, Priya Choudhry, Antonia Lopez-Girona, Weili Miao, Sandy W Wong, Jeffrey L Wolf, Thomas G Martin, Nina Shah, Scott Vandenberg, Sonam Prakash, Lenka Besse, Christoph Driessen, Avery D Posey, R Dyche Mullins, Justin Eyquem, James A Wells, Arun P Wiita.
      The myeloma surface proteome (surfaceome) determines tumor interaction with the microenvironment and serves as an emerging arena for therapeutic development. Here, we use glycoprotein capture proteomics to define the myeloma surfaceome at baseline, in drug resistance, and in response to acute drug treatment. We provide a scoring system for surface antigens and identify CCR10 as a promising target in this disease expressed widely on malignant plasma cells. We engineer proof-of-principle chimeric antigen receptor (CAR) T-cells targeting CCR10 using its natural ligand CCL27. In myeloma models we identify proteins that could serve as markers of resistance to bortezomib and lenalidomide, including CD53, CD10, EVI2B, and CD33. We find that acute lenalidomide treatment increases activity of MUC1-targeting CAR-T cells through antigen upregulation. Finally, we develop a miniaturized surface proteomic protocol for profiling primary plasma cell samples with low inputs. These approaches and datasets may contribute to the biological, therapeutic, and diagnostic understanding of myeloma.
    DOI:  https://doi.org/10.1038/s41467-022-31810-6
  20. Nat Commun. 2022 Jul 09. 13(1): 3998
    Acetyl-CoA-Carboxylase 1-mediated de novo fatty acid synthesis sustains Lgr5+ intestinal stem cell function.
    Shuting Li, Chia-Wen Lu, Elia C Diem, Wang Li, Melanie Guderian, Marc Lindenberg, Friederike Kruse, Manuela Buettner, Stefan Floess, Markus R Winny, Robert Geffers, Hans-Hermann Richnow, Wolf-Rainer Abraham, Guntram A Grassl, Matthias Lochner.
      Basic processes of the fatty acid metabolism have an important impact on the function of intestinal epithelial cells (IEC). However, while the role of cellular fatty acid oxidation is well appreciated, it is not clear how de novo fatty acid synthesis (FAS) influences the biology of IECs. We report here that interfering with de novo FAS by deletion of the enzyme Acetyl-CoA-Carboxylase (ACC)1 in IECs results in the loss of epithelial crypt structures and a specific decline in Lgr5+ intestinal epithelial stem cells (ISC). Mechanistically, ACC1-mediated de novo FAS supports the formation of intestinal organoids and the differentiation of complex crypt structures by sustaining the nuclear accumulation of PPARδ/β-catenin in ISCs. The dependency of ISCs on cellular de novo FAS is tuned by the availability of environmental lipids, as an excess delivery of external fatty acids is sufficient to rescue the defect in crypt formation. Finally, inhibition of ACC1 reduces the formation of tumors in colitis-associated colon cancer, together highlighting the importance of cellular lipogenesis for sustaining ISC function and providing a potential perspective to colon cancer therapy.
    DOI:  https://doi.org/10.1038/s41467-022-31725-2
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