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Bustraan S, Bennett J, Whilding C, Pennycook BR, Smith D, Barr AR, Read J, Carling D, Pollard A. AMP-activated protein kinase activation suppresses leptin expression independently of adipogenesis in primary murine adipocytes. Biochem J 2024; 481:345-362. [PMID: 38314646 DOI: 10.1042/bcj20240003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/01/2024] [Accepted: 02/04/2024] [Indexed: 02/06/2024]
Abstract
Adipogenesis, defined as the development of mature adipocytes from stem cell precursors, is vital for the expansion, turnover and health of adipose tissue. Loss of adipogenic potential in adipose stem cells, or impairment of adipogenesis is now recognised as an underlying cause of adipose tissue dysfunction and is associated with metabolic disease. In this study, we sought to determine the role of AMP-activated protein kinase (AMPK), an evolutionarily conserved master regulator of energy homeostasis, in adipogenesis. Primary murine adipose-derived stem cells were treated with a small molecule AMPK activator (BI-9774) during key phases of adipogenesis, to determine the effect of AMPK activation on adipocyte commitment, maturation and function. To determine the contribution of the repression of lipogenesis by AMPK in these processes, we compared the effect of pharmacological inhibition of acetyl-CoA carboxylase (ACC). We show that AMPK activation inhibits adipogenesis in a time- and concentration-dependent manner. Transient AMPK activation during adipogenic commitment leads to a significant, ACC-independent, repression of adipogenic transcription factor expression. Furthermore, we identify a striking, previously unexplored inhibition of leptin gene expression in response to both short-term and chronic AMPK activation irrespective of adipogenesis. These findings reveal that in addition to its effect on adipogenesis, AMPK activation switches off leptin gene expression in primary mouse adipocytes independently of adipogenesis. Our results identify leptin expression as a novel target of AMPK through mechanisms yet to be identified.
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Affiliation(s)
- Sophia Bustraan
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, U.K
- Medical Research Council Laboratory of Medical Sciences, London, U.K
| | - Jane Bennett
- Medical Research Council Laboratory of Medical Sciences, London, U.K
| | - Chad Whilding
- Medical Research Council Laboratory of Medical Sciences, London, U.K
| | | | - David Smith
- Emerging Innovations Unit, Discovery Sciences, R&D, AstraZeneca, Cambridge, U.K
| | - Alexis R Barr
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, U.K
- Medical Research Council Laboratory of Medical Sciences, London, U.K
| | - Jon Read
- Mechanistic and Structural Biology, Biopharmaceuticals R&D, AstraZeneca, Cambridge, U.K
| | - David Carling
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, U.K
- Medical Research Council Laboratory of Medical Sciences, London, U.K
| | - Alice Pollard
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, U.K
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2
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Ngo B, Kim E, Osorio-Vasquez V, Doll S, Bustraan S, Liang R, Luengo A, Davidson S, Ali A, Ferraro G, Fischer G, Plasger A, Rajasekhar V, Kastenhuber E, Eskandari R, Bacha S, Sriram R, Bakhoum S, Snuderl M, Cotzia P, Healey J, Sabatini D, Jones D, Zhao J, Yu M, Jain R, Keshari K, Davies M, Heiden MV, Hernando E, Mann M, Cantley L, Pacold M. DDRE-22. TARGETING SERINE SYNTHESIS IN BRAIN METASTASIS. Neurooncol Adv 2021. [PMCID: PMC7992201 DOI: 10.1093/noajnl/vdab024.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The brain environment is low in amino acids, including serine and glycine, both of which are important for tumor growth as they are precursors of proteins and nucleotide bases. How tumor cells overcome these conditions to proliferate and survive in the brain is incompletely understood. Here, we show that 3-phosphoglycerate dehydrogenase (PHGDH), which catalyzes the first and rate-limiting step of glucose-derived serine synthesis, enables brain metastasis in multiple human types and in preclinical models. Genetic suppression and small molecule inhibition of PHGDH attenuated brain metastasis, but not extra cranial tumors, and improved the overall survival of mice bearing brain metastasis. These results demonstrate that the tumor nutrient microenvironment determines tumor cell sensitivity to loss of serine synthesis pathway activity and raise the possibility that serine synthesis inhibitors may be useful in the treatment of brain metastases.
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Affiliation(s)
- Bryan Ngo
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | | | - Sophia Doll
- Max Planck Institute of Biochemistry, Martinsried, Germany
| | | | - Roger Liang
- Weill Cornell Medical College, New York, NY, USA
| | - Alba Luengo
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Ahmed Ali
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | | | | | | | | | | | - Sarah Bacha
- Weill Cornell Medical College, New York, NY, USA
| | | | - Samuel Bakhoum
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | | | - John Healey
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - David Sabatini
- Whitehead Institute for Biomedical Research, Cambridge, MA, USA
| | | | - Jean Zhao
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Min Yu
- University of Southern California, Los Angeles, CA, USA
| | - Rakesh Jain
- Massachusetts General Hospital, Boston, MA, USA
| | - Kayvan Keshari
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Matthias Mann
- Max Planck Institute of Biochemistry, Martinsried, Germany
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3
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Ngo B, Kim E, Osorio-Vasquez V, Doll S, Bustraan S, Liang RJ, Luengo A, Davidson SM, Ali A, Ferraro GB, Fischer GM, Eskandari R, Kang DS, Ni J, Plasger A, Rajasekhar VK, Kastenhuber ER, Bacha S, Sriram RK, Stein BD, Bakhoum SF, Snuderl M, Cotzia P, Healey JH, Mainolfi N, Suri V, Friedman A, Manfredi M, Sabatini DM, Jones DR, Yu M, Zhao JJ, Jain RK, Keshari KR, Davies MA, Vander Heiden MG, Hernando E, Mann M, Cantley LC, Pacold ME. Limited Environmental Serine and Glycine Confer Brain Metastasis Sensitivity to PHGDH Inhibition. Cancer Discov 2020; 10:1352-1373. [PMID: 32571778 PMCID: PMC7483776 DOI: 10.1158/2159-8290.cd-19-1228] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 04/15/2020] [Accepted: 06/17/2020] [Indexed: 12/19/2022]
Abstract
A hallmark of metastasis is the adaptation of tumor cells to new environments. Metabolic constraints imposed by the serine and glycine-limited brain environment restrict metastatic tumor growth. How brain metastases overcome these growth-prohibitive conditions is poorly understood. Here, we demonstrate that 3-phosphoglycerate dehydrogenase (PHGDH), which catalyzes the rate-limiting step of glucose-derived serine synthesis, is a major determinant of brain metastasis in multiple human cancer types and preclinical models. Enhanced serine synthesis proved important for nucleotide production and cell proliferation in highly aggressive brain metastatic cells. In vivo, genetic suppression and pharmacologic inhibition of PHGDH attenuated brain metastasis, but not extracranial tumor growth, and improved overall survival in mice. These results reveal that extracellular amino acid availability determines serine synthesis pathway dependence, and suggest that PHGDH inhibitors may be useful in the treatment of brain metastasis. SIGNIFICANCE: Using proteomics, metabolomics, and multiple brain metastasis models, we demonstrate that the nutrient-limited environment of the brain potentiates brain metastasis susceptibility to serine synthesis inhibition. These findings underscore the importance of studying cancer metabolism in physiologically relevant contexts, and provide a rationale for using PHGDH inhibitors to treat brain metastasis.This article is highlighted in the In This Issue feature, p. 1241.
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Affiliation(s)
- Bryan Ngo
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, New York
| | - Eugenie Kim
- Department of Radiation Oncology, Perlmutter Cancer Center and NYU Langone Health, New York, New York
| | - Victoria Osorio-Vasquez
- Department of Radiation Oncology, Perlmutter Cancer Center and NYU Langone Health, New York, New York
| | - Sophia Doll
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Sophia Bustraan
- Department of Radiation Oncology, Perlmutter Cancer Center and NYU Langone Health, New York, New York
| | - Roger J Liang
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, New York
| | - Alba Luengo
- Koch Institute for Integrative Cancer Research, Cambridge, Massachusetts
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Shawn M Davidson
- Lewis-Sigler Institute for Integrative Genomics, Princeton University, Princeton, New Jersey
| | - Ahmed Ali
- Koch Institute for Integrative Cancer Research, Cambridge, Massachusetts
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Gino B Ferraro
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Grant M Fischer
- Departments of Translational Molecular Pathology, Melanoma Medical Oncology, Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Roozbeh Eskandari
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Diane S Kang
- Department of Stem Cell Biology and Regenerative Medicine, University of Southern California Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, California
| | - Jing Ni
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, Massachusetts
| | - Ariana Plasger
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, New York
| | | | - Edward R Kastenhuber
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, New York
| | - Sarah Bacha
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, New York
| | - Roshan K Sriram
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, New York
| | - Benjamin D Stein
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, New York
| | - Samuel F Bakhoum
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matija Snuderl
- Department of Pathology, New York University Langone Health, New York, New York
| | - Paolo Cotzia
- Department of Pathology, New York University Langone Health, New York, New York
| | - John H Healey
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Vipin Suri
- Raze Therapeutics, Cambridge, Massachusetts
| | | | | | - David M Sabatini
- Whitehead Institute for Biomedical Research, Cambridge, Massachusetts
- Howard Hughes Medical Institute, Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Broad Institute, Cambridge, Massachusetts
| | - Drew R Jones
- Department of Radiation Oncology, Perlmutter Cancer Center and NYU Langone Health, New York, New York
- Metabolomics Core Resource Laboratory, NYU Langone Health, New York, New York
| | - Min Yu
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jean J Zhao
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, Massachusetts
- Broad Institute, Cambridge, Massachusetts
| | - Rakesh K Jain
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Kayvan R Keshari
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael A Davies
- Departments of Translational Molecular Pathology, Melanoma Medical Oncology, Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew G Vander Heiden
- Koch Institute for Integrative Cancer Research, Cambridge, Massachusetts
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Broad Institute, Cambridge, Massachusetts
| | - Eva Hernando
- Department of Pathology, New York University Langone Health, New York, New York
| | - Matthias Mann
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
- Faculty of Health and Medical Sciences, NNF Center for Protein Research, University of Copenhagen, Copenhagen, Denmark
| | - Lewis C Cantley
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, New York.
| | - Michael E Pacold
- Department of Radiation Oncology, Perlmutter Cancer Center and NYU Langone Health, New York, New York.
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4
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Ngo B, Kim E, Doll S, Bustraan S, Luengo A, Davidson SM, Ali A, Ferraro G, Kang D, Ni J, Liang R, Plasger A, Kastenhuber ER, Eskandari R, Bacha S, Sriram R, Stein BD, Bakhoum SF, Mullarky E, Snuderl M, Mainolfi N, Suri V, Friedman A, Manfredi M, Sabatini DM, Jones D, Yu M, Zhao JJ, Jain RK, Heiden MGV, Mann M, Cantley LC, Pacold ME. Abstract 5712: Nutrient scarcity confers breast cancer brain metastasis sensitivity to serine synthesis pathway inhibition. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-5712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The metabolic milieu of the brain is severely deprived of nutrients, including the amino acids serine and its catabolite glycine. The metabolic rewiring required for tumor cells to survive in the nutrient-limited environment of the brain and the metabolic vulnerabilities this confers are poorly understood.
Here we demonstrate that cell-intrinsic de novo serine synthesis is a major determinant of triple-negative breast cancer (TNBC) brain metastasis. Whole proteome comparison of TNBC cells that differ in their capacity to colonize the brain reveals that 3-phosphoglycerate dehydrogenase (PHGDH), which catalyzes the rate-limiting step of glucose-derived serine synthesis, is the most significantly upregulated protein in cells that efficiently metastasize to the brain. Expression of catalytically active PHGDH in a non-brain trophic cell line promoted brain metastasis. Furthermore, genetic silencing or pharmacological inhibition of PHGDH attenuated brain metastasis burden in mice.
These findings indicate that nutrient availability determines serine synthesis pathway dependence in brain metastasis, and suggest that PHGDH inhibitors may be useful in the treatment of patients with cancers that have spread to the brain.
Citation Format: Bryan Ngo, Eugenie Kim, Sophia Doll, Sophia Bustraan, Alba Luengo, Shawn M. Davidson, Ahmed Ali, Gino Ferraro, Diane Kang, Jing Ni, Roger Liang, Ariana Plasger, Edward R. Kastenhuber, Roozbeh Eskandari, Sarah Bacha, Roshan Sriram, Benjamin D. Stein, Samuel F. Bakhoum, Edouard Mullarky, Matija Snuderl, Nello Mainolfi, Vipin Suri, Adam Friedman, Mark Manfredi, David M. Sabatini, Drew Jones, Min Yu, Jean J. Zhao, Rakesh K. Jain, Matthew G. Vander Heiden, Matthias Mann, Lewis C. Cantley, Michael E. Pacold. Nutrient scarcity confers breast cancer brain metastasis sensitivity to serine synthesis pathway inhibition [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5712.
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Affiliation(s)
- Bryan Ngo
- 1Weill Cornell Medicine, New York, NY
| | | | - Sophia Doll
- 3University of Copenhagen, Copenhagen, Denmark
| | | | - Alba Luengo
- 4Massachusetts Institute of Technology, Cambridge, MA
| | | | - Ahmed Ali
- 4Massachusetts Institute of Technology, Cambridge, MA
| | | | - Diane Kang
- 7University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Jing Ni
- 2NYU Langone Medical Center, New York, NY
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Drew Jones
- 2NYU Langone Medical Center, New York, NY
| | - Min Yu
- 7University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | | | | | - Matthias Mann
- 12Max Planck Institute of Biochemistry, Martinsried, Germany
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5
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Rahman S, Magnussen M, León TE, Farah N, Li Z, Abraham BJ, Alapi KZ, Mitchell RJ, Naughton T, Fielding AK, Pizzey A, Bustraan S, Allen C, Popa T, Pike-Overzet K, Garcia-Perez L, Gale RE, Linch DC, Staal FJT, Young RA, Look AT, Mansour MR. Activation of the LMO2 oncogene through a somatically acquired neomorphic promoter in T-cell acute lymphoblastic leukemia. Blood 2017; 129:3221-3226. [PMID: 28270453 PMCID: PMC5472898 DOI: 10.1182/blood-2016-09-742148] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 02/22/2017] [Indexed: 01/17/2023] Open
Abstract
Somatic mutations within noncoding genomic regions that aberrantly activate oncogenes have remained poorly characterized. Here we describe recurrent activating intronic mutations of LMO2, a prominent oncogene in T-cell acute lymphoblastic leukemia (T-ALL). Heterozygous mutations were identified in PF-382 and DU.528 T-ALL cell lines in addition to 3.7% of pediatric (6 of 160) and 5.5% of adult (9 of 163) T-ALL patient samples. The majority of indels harbor putative de novo MYB, ETS1, or RUNX1 consensus binding sites. Analysis of 5'-capped RNA transcripts in mutant cell lines identified the usage of an intermediate promoter site, with consequential monoallelic LMO2 overexpression. CRISPR/Cas9-mediated disruption of the mutant allele in PF-382 cells markedly downregulated LMO2 expression, establishing clear causality between the mutation and oncogene dysregulation. Furthermore, the spectrum of CRISPR/Cas9-derived mutations provides important insights into the interconnected contributions of functional transcription factor binding. Finally, these mutations occur in the same intron as retroviral integration sites in gene therapy-induced T-ALL, suggesting that such events occur at preferential sites in the noncoding genome.
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Affiliation(s)
- Sunniyat Rahman
- Department of Haematology, University College London Cancer Institute, London, United Kingdom
| | - Michael Magnussen
- Department of Haematology, University College London Cancer Institute, London, United Kingdom
| | - Theresa E León
- Department of Haematology, University College London Cancer Institute, London, United Kingdom
| | - Nadine Farah
- Department of Haematology, University College London Cancer Institute, London, United Kingdom
| | - Zhaodong Li
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - Krisztina Z Alapi
- Department of Haematology, University College London Cancer Institute, London, United Kingdom
| | - Rachel J Mitchell
- Department of Haematology, University College London Cancer Institute, London, United Kingdom
| | - Tom Naughton
- Department of Haematology, University College London Cancer Institute, London, United Kingdom
| | - Adele K Fielding
- Department of Haematology, University College London Cancer Institute, London, United Kingdom
| | - Arnold Pizzey
- Department of Haematology, University College London Cancer Institute, London, United Kingdom
| | - Sophia Bustraan
- Department of Haematology, University College London Cancer Institute, London, United Kingdom
| | - Christopher Allen
- Department of Haematology, University College London Cancer Institute, London, United Kingdom
| | - Teodora Popa
- Department of Haematology, University College London Cancer Institute, London, United Kingdom
| | - Karin Pike-Overzet
- Department of Immunohematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Laura Garcia-Perez
- Department of Immunohematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rosemary E Gale
- Department of Haematology, University College London Cancer Institute, London, United Kingdom
| | - David C Linch
- Department of Haematology, University College London Cancer Institute, London, United Kingdom
| | - Frank J T Staal
- Department of Immunohematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Richard A Young
- Whitehead Institute for Biomedical Research, Cambridge, MA
- Department of Biology, Massachusetts Institute of Technology, Cambridge, MA; and
| | - A Thomas Look
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Division of Hematology/Oncology, Children's Hospital, Boston, MA
| | - Marc R Mansour
- Department of Haematology, University College London Cancer Institute, London, United Kingdom
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Dickson GJ, Bustraan S, Hills RK, Ali A, Goldstone AH, Burnett AK, Linch DC, Gale RE. The value of molecular stratification for CEBPA(DM) and NPM1(MUT) FLT3(WT) genotypes in older patients with acute myeloid leukaemia. Br J Haematol 2016; 172:573-80. [PMID: 26847745 PMCID: PMC4855634 DOI: 10.1111/bjh.13873] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 10/30/2015] [Indexed: 11/29/2022]
Abstract
Older adult patients (≥60 years) with acute myeloid leukaemia (AML) are generally considered to be poor-risk and there is limited information available regarding risk stratification based on molecular characterization in this age group, particularly for the double-mutant CEBPA (CEBPA(DM) ) genotype. To investigate whether a molecular favourable-risk genotype can be identified, we investigated CEBPA, NPM1 and FLT3 status and prognostic impact in a cohort of 301 patients aged 60 years or more with intermediate-risk cytogenetics, all treated intensively. Overall survival (OS) at 1 year was highest in the 12 patients (4%) that were CEBPA(DM) compared to the 76 (28%) with a mutant NPM1 and wild-type FLT3 (NPM1(MUT) FLT3(WT) ) genotype or all other patients (75%, 54%, 33% respectively), with median survival 15·2, 13·6 and 6·6 months, although the benefit was short-term (OS at 3 years 17%, 29%, 12% respectively). Combination of the CEBPA(DM) and NPM1(MUT) FLT3(WT) genotype patients defined a molecular group with favourable prognosis (P < 0·0001 in multivariate analysis), with 57% of patients alive at 1 year compared to 33% for all other patients. Knowledge of genotype in older cytogenetically intermediate-risk patients might influence therapy decisions.
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Affiliation(s)
- Glenda J. Dickson
- Department of HaematologyUniversity College London Cancer InstituteLondonUK
- Present address: Department of Haemato‐OncologyKing's College LondonLondonUK
| | - Sophia Bustraan
- Department of HaematologyUniversity College London Cancer InstituteLondonUK
| | - Robert K. Hills
- Department of HaematologyCardiff University School of MedicineCardiffUK
| | - Akbar Ali
- Department of HaematologyUniversity College London Cancer InstituteLondonUK
- Present address: Faculty of PharmacyNorthern Border UniversityRafhaSaudi Arabia
| | | | - Alan K. Burnett
- Department of HaematologyCardiff University School of MedicineCardiffUK
- Present address: CTI Life Sciences Ltd.UxbridgeUK
| | - David C. Linch
- Department of HaematologyUniversity College London Cancer InstituteLondonUK
| | - Rosemary E. Gale
- Department of HaematologyUniversity College London Cancer InstituteLondonUK
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