Biological features of leukaemic cells associated with autonomous growth and reduced survival in acute myeloblastic leukaemia.

The blast cells from up to 70% of patients with acute myeloblastic leukaemia exhibit a variable degree of autonomous growth in vitro, which is related to the production of autocrine growth factors. It has recently been established that patients with autonomous blast cell growth have both a lower remission rate and a higher relapse rate, compared to otherwise comparable patients whose blasts exhibit non-autonomous in vitro growth. In a group of 50 patients the actuarial disease-free survival for the autonomous growth group was 11% at 5 years compared to greater than 50% for the non-autonomous growth group. This data suggests that AML blasts with autocrine growth characteristics may be resistant to cytotoxic drug therapy. Here we present further data demonstrating that AML blasts with autonomous growth are relatively resistant to the induction of programmed cell death (apoptosis) and that this is related to the autocrine production of GM-CSF. Also AML blasts with autonomous growths have aberrant expression of genes associated with resistance to apoptosis induced by cytotoxic drugs. These include high expression of the bcl-2 oncoprotein and abnormalities of expression of the p53 tumour suppressor gene. Furthermore bcl-2 expression was found to be unregulated by both exogenous and autocrine GM-CSF suggesting that the documented negative prognostic effect of autonomous growth on treatment outcome in AML, is in part due to the regulatory effect of autocrine GM-CSF on bcl-2 expression, thus protecting cells from apoptosis induced by cytotoxic drug therapy.