Increased mitochondrial apoptotic priming with targeted therapy predicts clinical response to re‐induction chemotherapy
Year: 2019
Type: article
Abstract: Most patients with relapsed or refractory (R/R) acute myeloid leukemia (AML) do not benefit from current re-induction or approved targeted therapies. In the absence of targetable genetic mutations, there is minimal guidance on optimal treatment selection particularly in the R/R setting highlighting an unmet need for clinically useful functional biomarkers. Blood and bone marrow samples from patients treated on two clinical trials were used to test the combination of lenalidomide (LEN) and MEC (mitoxantrone, etoposide, and cytarabine) chemotherapy in R/R AML patients. The bone marrow samples were available to test the clinical utility of the mitochondrial apoptotic BH3 and dynamic BH3 profiling (DBP) assays in predicting response, as there was no clear genetic biomarker identifying responders. To test whether LEN-induced mitochondrial priming predicted clinical response to LEN-MEC therapy, we performed DBP on patient myeloblasts. We found that short-term ex vivo treatment with lenalidomide discriminated clinical responders from non-responders based on drug-induced change in priming (delta priming). Using paired patient samples collected before and after clinical LEN treatment (prior to MEC dosing), we confirmed LEN-induced increased apoptotic priming in vivo, suggesting LEN enhanced vulnerability of myeloblasts to cytotoxic MEC chemotherapy. This is the first study demonstrating the potential role of DBP in predicting clinical response to a combination regimen. Our findings demonstrate that functional properties of relapsed AML can identify active therapies.
Source: American Journal of Hematology
DOI: 10.1002/ajh.25692
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: Howard Hughes Medical Institute, American Association for Cancer Research, Conquer Cancer Foundation, Amgen, Pfizer, AstraZeneca, Leukemia and Lymphoma Society, Dr. Miriam and Sheldon G. Adelson Medical Research Foundation, Celgene, Dana-Farber/Harvard Cancer Center, European Hematology Association, Edward P. Evans Foundation, Actinium Pharmaceuticals, Jazz Pharmaceuticals, Agios Pharmaceuticals, Arog Pharmaceuticals, Argenx, Astellas Pharma, National Institutes of Health, Genentech, Takeda Oncology, National Cancer Institute
Awards: G1570399396, G2019256308, G3098844538, G4356369037, Enhancing Venetoclax Activity in Chemoresistant Acute Myeloid Leukemia, Center of Excellence for High Throughput Proteogenomic Characterization, MICROSCALED PROTEOGENOMICS FOR CANCER CLINICAL TRIALS, G7145486612, SPORE in Myeloid Malignancies, G8722670318, G9000014437, G9000137291
OpenAlex ID: W2992226428