Journal
NATURE MEDICINE
Volume 25, Issue 4, Pages 603-+Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/s41591-019-0400-z
Keywords
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Funding
- Italian Ministry of Health [RF-FSR-2008-1202648, RF-2011-02351998, RF-2011-02348034]
- Italian Ministry of University and Research [MIUR-2015NZWSEC-001]
- CARIPLO Foundation [2009-2665]
- Associazione Italiana per la Ricerca sul Cancro [18458, 12042, 14162]
- ASCO Conquer Cancer Foundation
- EU-FP7
- Deutsche Jose Carreras Leukamie Stiftung [DJCLS R 15-02, DJCLS 01 R/2017]
- DKMS Mechtild Harf Foundation (DKMS Mechtild Harf Research Grant 2015)
- Associazione Italiana per la Ricerca sul Cancro postdoctoral fellowship
- Fondazione Matarelli fellowship from the Associazione Italiana Leucemie
- Fondazione Umberto Veronesi fellowship
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Transplantation of hematopoietic cells from a healthy individual (allogeneic hematopoietic cell transplantation (allo-HCT)) demonstrates that adoptive immunotherapy can cure blood cancers: still, post-transplantation relapses remain frequent. To explain their drivers, we analyzed the genomic and gene expression profiles of acute myeloid leukemia (AML) blasts purified from patients at serial time-points during their disease history. We identified a transcriptional signature specific for post-transplantation relapses and highly enriched in immune-related processes, including T cell costimulation and antigen presentation. In two independent patient cohorts we confirmed the deregulation of multiple costimulatory ligands on AML blasts at post-transplantation relapse (PD-L1, B7-H3, CD80, PVRL2), mirrored by concomitant changes in circulating donor T cells. Likewise, we documented the frequent loss of surface expression of HLA-DR, -DQ and -DP on leukemia cells, due to downregulation of the HLA class II regulator CIITA. We show that loss of HLA class II expression and upregulation of inhibitory checkpoint molecules represent alternative modalities to abolish AML recognition from donor-derived T cells, and can be counteracted by interferon-gamma or checkpoint blockade, respectively. Our results demonstrate that the deregulation of pathways involved in T cell-mediated allorecognition is a distinctive feature and driver of AML relapses after allo-HCT, which can be rapidly translated into personalized therapies.
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