Department of Hematology, Hokkaido University Faculty of Medicine, Graduate School of Medicine, Sapporo, 060-8638, Japan.
Drug Discovery Research, Astellas Pharma Inc., Tsukuba, Japan.
Bone Marrow Transplant. 2022 May;57(5):775-780. doi: 10.1038/s41409-022-01619-4. Epub 2022 Feb 28.
Allogeneic hematopoietic stem cell transplantation (allo-SCT) is a potentially curative therapy for FLT3 internal tandem duplication mutant (FLT3-ITD) acute myeloid leukemia, but relapse rate is high. A recent study showed that sorafenib, a first generation FLT3 and multikinase inhibitor, enhanced graft-versus-leukemia (GVL) effects against FLT3-ITD leukemia via interleukin-15 (IL-15) production. However, it remains to be clarified whether this effect could be mediated by selective FLT3 inhibition. We investigated whether gilteritinib, a selective FLT3 inhibitor, could enhance GVL effects against FLT3-ITD transfected Ba/F3 leukemia (Ba/F3-FLT3-ITD) in mice. Oral administration of gilteritinib from day +5 to +14 after allo-SCT reduced expression of the co-inhibitory receptors PD-1 and TIGIT on donor CD8 T cells and enhanced IL-15 expression in Ba/F3-FLT3-ITD. Bioluminescent imaging using luciferase-transfected Ba/F3-FLT3-ITD demonstrated that gilteritinib significantly suppressed leukemia expansion after allo-SCT, whereas it did not impact the morbidity or mortality of graft-versus-host disease (GVHD), resulting in significant improvement of overall survival. In conclusion, short-term administration of gilteritinib after allo-SCT enhanced GVL effects against FLT3-ITD leukemia without exacerbating GVHD.
异基因造血干细胞移植(allo-SCT)是 FLT3 内部串联重复突变(FLT3-ITD)急性髓系白血病的一种潜在治愈性疗法,但复发率很高。最近的一项研究表明,索拉非尼是一种第一代 FLT3 和多激酶抑制剂,通过产生白细胞介素-15(IL-15)增强了针对 FLT3-ITD 白血病的移植物抗白血病(GVL)效应。然而,尚不清楚这种效应是否可以通过选择性 FLT3 抑制来介导。我们研究了选择性 FLT3 抑制剂吉特替尼是否可以增强针对 FLT3-ITD 转染的 Ba/F3 白血病(Ba/F3-FLT3-ITD)的 GVL 效应。在 allo-SCT 后第+5 天至+14 天给予吉特替尼口服治疗可降低供体 CD8 T 细胞上共抑制受体 PD-1 和 TIGIT 的表达,并增强 Ba/F3-FLT3-ITD 中的 IL-15 表达。使用荧光素酶转染的 Ba/F3-FLT3-ITD 进行生物发光成像表明,吉特替尼在 allo-SCT 后显著抑制白血病扩增,而不影响移植物抗宿主病(GVHD)的发病率或死亡率,从而显著提高总生存率。总之,allo-SCT 后短期给予吉特替尼可增强针对 FLT3-ITD 白血病的 GVL 效应,而不会加重 GVHD。