Pharmacotypes across the genomic landscape of pediatric acute lymphoblastic leukemia and impact on treatment response.
Shawn H R LeeWenjian YangYoshihiro GochoAugust J JohnLauren RowlandBrandon SmartHannah E WilliamsDylan MaxwellJeremy HuntWentao YangKristine R CrewsKathryn G RobertsSima JehaCheng ChengSeth E KarolMary V RellingGary L RosnerHiroto InabaCharles G MullighanChing-Hong PuiWilliams E EvansJun J YangPublished in: Nature medicine (2023)
Contemporary chemotherapy for childhood acute lymphoblastic leukemia (ALL) is risk-adapted based on clinical features, leukemia genomics and minimal residual disease (MRD); however, the pharmacological basis of these prognostic variables remains unclear. Analyzing samples from 805 children with newly diagnosed ALL from three consecutive clinical trials, we determined the ex vivo sensitivity of primary leukemia cells to 18 therapeutic agents across 23 molecular subtypes defined by leukemia genomics. There was wide variability in drug response, with favorable ALL subtypes exhibiting the greatest sensitivity to L-asparaginase and glucocorticoids. Leukemia sensitivity to these two agents was highly associated with MRD although with distinct patterns and only in B cell ALL. We identified six patient clusters based on ALL pharmacotypes, which were associated with event-free survival, even after adjusting for MRD. Pharmacotyping identified a T cell ALL subset with a poor prognosis that was sensitive to targeted agents, pointing to alternative therapeutic strategies. Our study comprehensively described the pharmacological heterogeneity of ALL, highlighting opportunities for further individualizing therapy for this most common childhood cancer.
Keyphrases
- acute lymphoblastic leukemia
- poor prognosis
- childhood cancer
- acute myeloid leukemia
- single cell
- bone marrow
- free survival
- young adults
- clinical trial
- newly diagnosed
- allogeneic hematopoietic stem cell transplantation
- long non coding rna
- induced apoptosis
- squamous cell carcinoma
- randomized controlled trial
- cell death
- cell cycle arrest
- signaling pathway
- emergency department
- copy number
- dna methylation
- drug delivery
- cell proliferation
- adverse drug
- electronic health record