Tyrosine kinase inhibitor resistance in de novo BCR::ABL1-positive BCP-ALL beyond kinase domain mutations.
Inge van OutersterpJudith M BoerCesca van de VenCaitlin E J ReichertAurelie BoereeBrian KruisingaHester A de Groot-KrusemanGabriele EscherichAniko Sijs-SzaboAnita W RijneveldMonique L den BoerPublished in: Blood advances (2024)
A better understanding of ABL1 kinase domain mutation-independent causes of tyrosine kinase inhibitor (TKI) resistance is needed for BCR::ABL1-positive B-cell precursor acute lymphoblastic leukemia (BCP-ALL). Although TKIs have dramatically improved outcomes, a subset of patients still experiences relapsed or refractory disease. We aimed to identify potential biomarkers of intrinsic TKI resistance at diagnosis in samples from 32 pediatric and 19 adult patients with BCR::ABL1-positive BCP-ALL. Reduced ex vivo imatinib sensitivity was observed in cells derived from newly diagnosed patients who relapsed after combined TKI and chemotherapy treatment compared with cells derived from patients who remained in continuous complete remission. We observed that ex vivo imatinib resistance was inversely correlated with the amount of (phosphorylated) BCR::ABL1/ABL1 protein present in samples that were taken at diagnosis without prior TKI exposure. This suggests an intrinsic cause of TKI resistance that is independent of functional BCR::ABL1 signaling. Simultaneous deletions of IKZF1 and CDKN2A/B and/or PAX5 (IKZF1plus), as well as deletions of PAX5 alone, were related to ex vivo imatinib resistance. In addition, somatic lesions involving ZEB2, SETD2, SH2B3, and CRLF2 were associated with reduced ex vivo imatinib sensitivity. Our data suggest that the poor prognostic value of IKZF1(plus) deletions is linked to intrinsic mechanisms of TKI resistance other than ABL1 kinase domain mutations in newly diagnosed pediatric and adult BCR::ABL1-positive BCP-ALL.
Keyphrases
- chronic myeloid leukemia
- acute lymphoblastic leukemia
- tyrosine kinase
- newly diagnosed
- induced apoptosis
- allogeneic hematopoietic stem cell transplantation
- epidermal growth factor receptor
- acute myeloid leukemia
- multiple myeloma
- gene expression
- rheumatoid arthritis
- adipose tissue
- radiation therapy
- oxidative stress
- cell cycle arrest
- protein kinase
- metabolic syndrome
- chronic kidney disease
- dna methylation
- skeletal muscle
- genome wide
- diffuse large b cell lymphoma
- young adults
- cell death
- combination therapy
- cell proliferation
- weight loss
- data analysis
- electronic health record
- disease activity
- patient reported outcomes