Mutant FLT3: A direct target of sorafenib in acute myelogenous leukemia

Weiguo Zhang, Marina Konopleva, Yue Xi Shi, Teresa McQueen, David Harris, Xiaoyang Ling, Zeev Estrov, Alfonso Quintás-Cardama, Donald Small, Jorge Cortes, Michael Andreeff

Research output: Contribution to journalArticle

Abstract

Background: Internal tandem duplication (ITD) mutations in the juxtamembrane domain-coding sequence of the Fms-like tyrosine kinase 3 (FLT3) gene have been identified in 30% of acute myeloid leukemia (AML) patients and are associated with a poor prognosis. The kinase inhibitor sorafenib induces growth arrest and apoptosis at much lower concentrations in AML cell lines that harbor FLT3-ITD mutations than in AML cell lines with wild-type FLT3. Methods: The antileukemic activity of sorafenib was investigated in isogenic murine Ba/F3 AML cell lines that expressed mutant (ITD, D835G, and D835Y) or wild-type human FLT3, in primary human AML cells, and in a mouse leukemia xenograft model. Effects of sorafenib on apoptosis and signaling in AML cell lines were investigated by flow cytometry and immunoblot analysis, respectively, and the in vivo effects were determined by monitoring the survival of leukemia xenograft-bearing mice treated with sorafenib (groups of 15 mice). In a phase 1 clinical trial, 16 patients with refractory or relapsed AML were treated with sorafenib on different dose schedules. We determined their FLT3 mutation status by a polymerase chain reaction assay and analyzed clinical responses by standard criteria. All statistical tests were two-sided. Results: Sorafenib was 1000- to 3000-fold more effective in inducing growth arrest and apoptosis in Ba/F3 cells with FLT3-ITD or D835G mutations than in Ba/F3 cells with FLT3-D835Y mutant or wild-type FLT3 and inhibited the phosphorylation of tyrosine residues in ITD mutant but not wild-type FLT3 protein. In a mouse model, sorafenib decreased the leukemia burden and prolonged survival (median survival in the sorafenib-treated group vs the vehicle-treated group = 36.5 vs 16 days, difference = 20.5 days, 95% confidence interval = 20.3 to 21.3 days; P =. 0018). Sorafenib reduced the percentage of leukemia blasts in the peripheral blood and the bone marrow of AML patients with FLT3-ITD (median percentages before and after sorafenib: 81% vs 7.5% [P =. 016] and 75.5% vs 34% [P =. 05], respectively) but not in patients without this mutation. Conclusion: Sorafenib may have therapeutic efficacy in AML patients whose cells harbor FLT3-ITD mutations.

Original languageEnglish (US)
Pages (from-to)184-198
Number of pages15
JournalJournal of the National Cancer Institute
Volume100
Issue number3
DOIs
StatePublished - Feb 1 2008
Externally publishedYes

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fms-Like Tyrosine Kinase 3
Acute Myeloid Leukemia
Myeloid Cells
Mutation
Leukemia
Cell Line
Apoptosis
Heterografts
Survival
sorafenib
Clinical Trials, Phase I
Growth

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Zhang, W., Konopleva, M., Shi, Y. X., McQueen, T., Harris, D., Ling, X., ... Andreeff, M. (2008). Mutant FLT3: A direct target of sorafenib in acute myelogenous leukemia. Journal of the National Cancer Institute, 100(3), 184-198. https://doi.org/10.1093/jnci/djm328

Mutant FLT3 : A direct target of sorafenib in acute myelogenous leukemia. / Zhang, Weiguo; Konopleva, Marina; Shi, Yue Xi; McQueen, Teresa; Harris, David; Ling, Xiaoyang; Estrov, Zeev; Quintás-Cardama, Alfonso; Small, Donald; Cortes, Jorge; Andreeff, Michael.

In: Journal of the National Cancer Institute, Vol. 100, No. 3, 01.02.2008, p. 184-198.

Research output: Contribution to journalArticle

Zhang, W, Konopleva, M, Shi, YX, McQueen, T, Harris, D, Ling, X, Estrov, Z, Quintás-Cardama, A, Small, D, Cortes, J & Andreeff, M 2008, 'Mutant FLT3: A direct target of sorafenib in acute myelogenous leukemia', Journal of the National Cancer Institute, vol. 100, no. 3, pp. 184-198. https://doi.org/10.1093/jnci/djm328
Zhang, Weiguo ; Konopleva, Marina ; Shi, Yue Xi ; McQueen, Teresa ; Harris, David ; Ling, Xiaoyang ; Estrov, Zeev ; Quintás-Cardama, Alfonso ; Small, Donald ; Cortes, Jorge ; Andreeff, Michael. / Mutant FLT3 : A direct target of sorafenib in acute myelogenous leukemia. In: Journal of the National Cancer Institute. 2008 ; Vol. 100, No. 3. pp. 184-198.
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abstract = "Background: Internal tandem duplication (ITD) mutations in the juxtamembrane domain-coding sequence of the Fms-like tyrosine kinase 3 (FLT3) gene have been identified in 30{\%} of acute myeloid leukemia (AML) patients and are associated with a poor prognosis. The kinase inhibitor sorafenib induces growth arrest and apoptosis at much lower concentrations in AML cell lines that harbor FLT3-ITD mutations than in AML cell lines with wild-type FLT3. Methods: The antileukemic activity of sorafenib was investigated in isogenic murine Ba/F3 AML cell lines that expressed mutant (ITD, D835G, and D835Y) or wild-type human FLT3, in primary human AML cells, and in a mouse leukemia xenograft model. Effects of sorafenib on apoptosis and signaling in AML cell lines were investigated by flow cytometry and immunoblot analysis, respectively, and the in vivo effects were determined by monitoring the survival of leukemia xenograft-bearing mice treated with sorafenib (groups of 15 mice). In a phase 1 clinical trial, 16 patients with refractory or relapsed AML were treated with sorafenib on different dose schedules. We determined their FLT3 mutation status by a polymerase chain reaction assay and analyzed clinical responses by standard criteria. All statistical tests were two-sided. Results: Sorafenib was 1000- to 3000-fold more effective in inducing growth arrest and apoptosis in Ba/F3 cells with FLT3-ITD or D835G mutations than in Ba/F3 cells with FLT3-D835Y mutant or wild-type FLT3 and inhibited the phosphorylation of tyrosine residues in ITD mutant but not wild-type FLT3 protein. In a mouse model, sorafenib decreased the leukemia burden and prolonged survival (median survival in the sorafenib-treated group vs the vehicle-treated group = 36.5 vs 16 days, difference = 20.5 days, 95{\%} confidence interval = 20.3 to 21.3 days; P =. 0018). Sorafenib reduced the percentage of leukemia blasts in the peripheral blood and the bone marrow of AML patients with FLT3-ITD (median percentages before and after sorafenib: 81{\%} vs 7.5{\%} [P =. 016] and 75.5{\%} vs 34{\%} [P =. 05], respectively) but not in patients without this mutation. Conclusion: Sorafenib may have therapeutic efficacy in AML patients whose cells harbor FLT3-ITD mutations.",
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AU - Zhang, Weiguo

AU - Konopleva, Marina

AU - Shi, Yue Xi

AU - McQueen, Teresa

AU - Harris, David

AU - Ling, Xiaoyang

AU - Estrov, Zeev

AU - Quintás-Cardama, Alfonso

AU - Small, Donald

AU - Cortes, Jorge

AU - Andreeff, Michael

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N2 - Background: Internal tandem duplication (ITD) mutations in the juxtamembrane domain-coding sequence of the Fms-like tyrosine kinase 3 (FLT3) gene have been identified in 30% of acute myeloid leukemia (AML) patients and are associated with a poor prognosis. The kinase inhibitor sorafenib induces growth arrest and apoptosis at much lower concentrations in AML cell lines that harbor FLT3-ITD mutations than in AML cell lines with wild-type FLT3. Methods: The antileukemic activity of sorafenib was investigated in isogenic murine Ba/F3 AML cell lines that expressed mutant (ITD, D835G, and D835Y) or wild-type human FLT3, in primary human AML cells, and in a mouse leukemia xenograft model. Effects of sorafenib on apoptosis and signaling in AML cell lines were investigated by flow cytometry and immunoblot analysis, respectively, and the in vivo effects were determined by monitoring the survival of leukemia xenograft-bearing mice treated with sorafenib (groups of 15 mice). In a phase 1 clinical trial, 16 patients with refractory or relapsed AML were treated with sorafenib on different dose schedules. We determined their FLT3 mutation status by a polymerase chain reaction assay and analyzed clinical responses by standard criteria. All statistical tests were two-sided. Results: Sorafenib was 1000- to 3000-fold more effective in inducing growth arrest and apoptosis in Ba/F3 cells with FLT3-ITD or D835G mutations than in Ba/F3 cells with FLT3-D835Y mutant or wild-type FLT3 and inhibited the phosphorylation of tyrosine residues in ITD mutant but not wild-type FLT3 protein. In a mouse model, sorafenib decreased the leukemia burden and prolonged survival (median survival in the sorafenib-treated group vs the vehicle-treated group = 36.5 vs 16 days, difference = 20.5 days, 95% confidence interval = 20.3 to 21.3 days; P =. 0018). Sorafenib reduced the percentage of leukemia blasts in the peripheral blood and the bone marrow of AML patients with FLT3-ITD (median percentages before and after sorafenib: 81% vs 7.5% [P =. 016] and 75.5% vs 34% [P =. 05], respectively) but not in patients without this mutation. Conclusion: Sorafenib may have therapeutic efficacy in AML patients whose cells harbor FLT3-ITD mutations.

AB - Background: Internal tandem duplication (ITD) mutations in the juxtamembrane domain-coding sequence of the Fms-like tyrosine kinase 3 (FLT3) gene have been identified in 30% of acute myeloid leukemia (AML) patients and are associated with a poor prognosis. The kinase inhibitor sorafenib induces growth arrest and apoptosis at much lower concentrations in AML cell lines that harbor FLT3-ITD mutations than in AML cell lines with wild-type FLT3. Methods: The antileukemic activity of sorafenib was investigated in isogenic murine Ba/F3 AML cell lines that expressed mutant (ITD, D835G, and D835Y) or wild-type human FLT3, in primary human AML cells, and in a mouse leukemia xenograft model. Effects of sorafenib on apoptosis and signaling in AML cell lines were investigated by flow cytometry and immunoblot analysis, respectively, and the in vivo effects were determined by monitoring the survival of leukemia xenograft-bearing mice treated with sorafenib (groups of 15 mice). In a phase 1 clinical trial, 16 patients with refractory or relapsed AML were treated with sorafenib on different dose schedules. We determined their FLT3 mutation status by a polymerase chain reaction assay and analyzed clinical responses by standard criteria. All statistical tests were two-sided. Results: Sorafenib was 1000- to 3000-fold more effective in inducing growth arrest and apoptosis in Ba/F3 cells with FLT3-ITD or D835G mutations than in Ba/F3 cells with FLT3-D835Y mutant or wild-type FLT3 and inhibited the phosphorylation of tyrosine residues in ITD mutant but not wild-type FLT3 protein. In a mouse model, sorafenib decreased the leukemia burden and prolonged survival (median survival in the sorafenib-treated group vs the vehicle-treated group = 36.5 vs 16 days, difference = 20.5 days, 95% confidence interval = 20.3 to 21.3 days; P =. 0018). Sorafenib reduced the percentage of leukemia blasts in the peripheral blood and the bone marrow of AML patients with FLT3-ITD (median percentages before and after sorafenib: 81% vs 7.5% [P =. 016] and 75.5% vs 34% [P =. 05], respectively) but not in patients without this mutation. Conclusion: Sorafenib may have therapeutic efficacy in AML patients whose cells harbor FLT3-ITD mutations.

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