Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Leukemia. 2019 Jun;33(6):1313-1323. doi: 10.1038/s41375-018-0315-6. Epub 2018 Dec 13.
BCR-ABL+acute lymphoblastic leukemia (ALL) in adults has a poor prognosis with allogeneic stem cell transplantation (SCT) considered the best curative option for suitable patients. We here characterize the curative potential of BH3-mimetics differentially targeting mitochondrial BCL2-family members using a combination therapy approach with dexamethasone and tyrosine kinase inhibitors targeting BCR-ABL. In BCR-ABL + ALL BH3-mimetics act by redistribution of mitochondrial activator BIM, which is strongly required for cytotoxicity of the BCL2-specific BH3-mimetic ABT-199, tyrosine kinase inhibitors (TKIs) and dexamethasone. BIM expression is enhanced by dexamethasone and TKIs and both synergize with ABT-199 in BCR-ABL + ALL. Triple combinations with ABT-199, dexamethasone and TKIs efficiently attenuate leukemia progression both in tissue culture and in primary cell xenotransplantation models. Notably, the dasatinib-containing combination led to treatment- and leukemia-free long-term survival in a BCR-ABL + mouse model. Finally, response to BH3-mimetics can be predicted for individual patients in a clinically relevant setting. These data demonstrate curative targeted and chemotherapy-free pharmacotherapy for BCR-ABL + ALL in a preclinical model. Clinical evaluation, in particular for patients not suitable for allogeneic SCT, is warranted.
BCR-ABL+急性淋巴细胞白血病(ALL)在成人中预后较差,异体干细胞移植(SCT)被认为是适合患者的最佳治愈选择。我们使用针对 BCR-ABL 的地塞米松和酪氨酸激酶抑制剂联合治疗方法,来描述针对线粒体 BCL2 家族成员的 BH3 模拟物的治疗潜力。在 BCR-ABL+ALL 中,BH3 模拟物通过重新分配线粒体激活剂 BIM 起作用,这对于 BCL2 特异性 BH3 模拟物 ABT-199、酪氨酸激酶抑制剂(TKI)和地塞米松的细胞毒性是必需的。地塞米松和 TKI 增强 BIM 的表达,并且在 BCR-ABL+ALL 中与 ABT-199 协同作用。ABT-199、地塞米松和 TKI 的三联组合在组织培养和原代细胞异种移植模型中均能有效抑制白血病进展。值得注意的是,含有达沙替尼的组合在 BCR-ABL+小鼠模型中导致了治疗和白血病无长期生存。最后,在临床相关环境中可以预测个体患者对 BH3 模拟物的反应。这些数据在临床前模型中证明了针对 BCR-ABL+ALL 的治疗性靶向和无化疗药物治疗。需要进行临床评估,特别是对于不适合异体 SCT 的患者。