EZH2-driven immune evasion defines high-risk pediatric AML with t(16;21) FUS::ERG gene fusion.
Nathaniel J ButeynConnor G BurkeVincent J SartoriEve Deering-GardnerZachary J DeBruineDahlya KamarudinDarrell P ChandlerAlexander C MonovichMonika W PerezJoanna S YiRhonda E RiesTodd A AlonzoRussell J H RyanSoheil MeshinchiTimothy J TrichePublished in: bioRxiv : the preprint server for biology (2024)
Despite decades of research, acute myeloid leukemia (AML) remains a remarkably lethal malignancy. While pediatric AML (pAML) carries a more favorable prognosis than adult AML, the past 25 years of large clinical trials have produced few improvements in pAML survival. Nowhere is this more evident than in patients carrying a t(16;21)(p11;q22) translocation, which yields the FUS::ERG fusion transcript. Patients with FUS::ERG -positive AML are often primary refractory, and most responders quickly relapse. In COG clinical trials, allogeneic stem cell transplantation was of no benefit to FUS::ERG pAML patients; 100% of transplanted patients succumbed to their disease. Expression of major histocompatibility complex (MHC) class I & II and costimulatory molecules is absent at diagnosis in FUS::ERG AML, mirroring the epigenetic mechanism of post-transplant relapse seen in adult AML and its associated dismal outcomes. Here we show that this class-defining immune-repressive phenotype is driven by overexpression of the EZH2 histone lysine methyltransferase in vitro and in multiple clinical cohorts. We show that treatment with the FDA-approved EZH2 inhibitor tazemetostat along with IFN-γ reverses this phenotype, re-establishes MHC presentation, and severely impairs the viability of FUS::ERG AML cells. EZH2 inhibitors may thus provide the first targeted therapeutic option for patients with this high-risk subtype of pAML, with particular benefit as a bridge to successful allogeneic stem cell transplantation.
Keyphrases
- acute myeloid leukemia
- stem cell transplantation
- end stage renal disease
- clinical trial
- ejection fraction
- allogeneic hematopoietic stem cell transplantation
- high dose
- newly diagnosed
- chronic kidney disease
- prognostic factors
- peritoneal dialysis
- bone marrow
- randomized controlled trial
- gene expression
- patient reported outcomes
- dendritic cells
- young adults
- poor prognosis
- rna seq
- skeletal muscle
- cell proliferation
- adipose tissue
- endoplasmic reticulum stress
- patient reported
- insulin resistance
- weight loss
- copy number
- binding protein
- double blind
- phase iii
- hematopoietic stem cell