在费城染色体阳性急性淋巴细胞白血病小鼠模型中,鲁索替尼抑制Janus激酶可延长达沙替尼和地塞米松诱导的缓解期。
Janus kinase inhibition by ruxolitinib extends dasatinib- and dexamethasone-induced remissions in a mouse model of Ph+ ALL.
作者信息
Appelmann Iris, Rillahan Cory D, de Stanchina Elisa, Carbonetti Gregory, Chen Chong, Lowe Scott W, Sherr Charles J
机构信息
Cancer Biology & Genetics Program, and.
Antitumor Assessment Core Facility, Memorial Sloan Kettering Cancer Center, New York, NY; and.
出版信息
Blood. 2015 Feb 26;125(9):1444-51. doi: 10.1182/blood-2014-09-601062. Epub 2014 Dec 12.
Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) is initiated and driven by the oncogenic fusion protein BCR-ABL, a constitutively active tyrosine kinase. Despite major advances in the treatment of this highly aggressive disease with potent inhibitors of the BCR-ABL kinase such as dasatinib, patients in remission frequently relapse due to persistent minimal residual disease possibly supported, at least in part, by salutary cytokine-driven signaling within the hematopoietic microenvironment. Using a mouse model of Ph+ ALL that accurately mimics the genetics, clinical behavior, and therapeutic response of the human disease, we show that a combination of 2 agents approved by the US Food and Drug Administration (dasatinib and ruxolitinib, which inhibit BCR-ABL and Janus kinases, respectively), significantly extends survival by targeting parallel signaling pathways. Although the BCR-ABL kinase cancels the cytokine requirement of immature leukemic B cells, dasatinib therapy restores cytokine dependency and sensitizes leukemic cells to ruxolitinib. As predicted, ruxolitinib alone had no significant antileukemic effect in this model, but it prevented relapse when administered with dasatinib. The combination of dasatinib, ruxolitinib, and the corticosteroid dexamethasone yielded more durable remissions, in some cases after completion of therapy, avoiding the potential toxicity of other cytotoxic chemotherapeutic agents.
费城染色体阳性急性淋巴细胞白血病(Ph+ ALL)由致癌融合蛋白BCR-ABL启动并驱动,BCR-ABL是一种组成型活性酪氨酸激酶。尽管使用达沙替尼等BCR-ABL激酶强效抑制剂治疗这种高度侵袭性疾病取得了重大进展,但缓解期患者仍频繁复发,原因可能是持续存在微小残留病,这至少部分是由造血微环境中有益的细胞因子驱动的信号传导所支持。利用一种能准确模拟人类疾病遗传学、临床行为和治疗反应的Ph+ ALL小鼠模型,我们发现美国食品药品监督管理局批准的两种药物(分别抑制BCR-ABL和Janus激酶的达沙替尼和鲁索替尼)联合使用,通过靶向平行信号通路可显著延长生存期。尽管BCR-ABL激酶消除了未成熟白血病B细胞对细胞因子的需求,但达沙替尼治疗可恢复细胞因子依赖性,并使白血病细胞对鲁索替尼敏感。正如预期的那样,单独使用鲁索替尼在该模型中没有显著的抗白血病作用,但与达沙替尼联合使用时可预防复发。达沙替尼、鲁索替尼和皮质类固醇地塞米松联合使用可产生更持久的缓解,在某些情况下是在治疗完成后,避免了其他细胞毒性化疗药物的潜在毒性。
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