4.7 Review

Translating recent advances in the pathogenesis of acute myeloid leukemia to the clinic

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Article Hematology

Phase 1 study of anti-CD47 monoclonal antibody CC-90002 in patients with relapsed/refractory acute myeloid leukemia and high-risk myelodysplastic syndromes

Amer M. Zeidan et al.

Summary: Y CC-90002 is an anti-CD47 antibody that inhibits CD47-SIRP alpha interaction and enables macrophage-mediated killing of tumor cells in hematological cancer cell lines. The phase 1 clinical trial in patients with relapsed/refractory AML or high-risk MDS showed that CC-90002 led to mostly adverse events such as diarrhea and thrombocytopenia, with no objective responses observed. Further studies are needed to understand the lack of monotherapy activity and the development of anti-drug antibodies in this treatment.

ANNALS OF HEMATOLOGY (2022)

Article Hematology

Effective therapy for AML with RUNX1 mutation by cotreatment with inhibitors of protein translation and BCL2

Christopher P. Mill et al.

Summary: Most RUNX1 mutations in acute myeloid leukemia (AML) are loss-of-function mutations. AML patients expressing mtRUNX1 have worse clinical outcomes than those without mutant RUNX1. Studies show that AML cells with mtRUNX1 have impaired ribosomal biogenesis and differentiation, as well as reduced levels of wild-type RUNX1, PU.1, and c-Myc. These cells are also more sensitive to protein translation inhibitors and a BCL2 inhibitor. Combination therapies involving omacetaxine are more effective for AML cells with mtRUNX1, with improved in vitro and in vivo efficacy.
Review Hematology

Immune checkpoint inhibition in myeloid malignancies: Moving beyond the PD-1/PD-L1 and CTLA-4 pathways

Jan Philipp Bewersdorf et al.

Summary: Immune checkpoint inhibitors have shown mixed results in clinical trials in patients with acute myeloid leukemia and myelodysplastic syndromes, but there is optimism for the future of this field. Advances in understanding the immunologic landscape, potential biomarkers, and resistance mechanisms provide hope, but challenges such as the lack of validated biomarkers and the development of safe combination therapies still need to be addressed.

BLOOD REVIEWS (2021)

Article Hematology

Synergistic activity of IDH1 inhibitor BAY1436032 with azacitidine in IDH1 mutant acute myeloid leukemia

Anuhar Chaturvedi et al.

Summary: The study demonstrates that the combination treatment of mIDH1 inhibitors and azacitidine has significant efficacy in AML patients, reducing leukemia stem cell numbers through different mechanisms and signaling pathways. The strong synergy between the two treatments is mediated through inhibition of MAPK/ERK and Rb/E2F signaling, suggesting an improved outcome for IDH1 mutated AML patients.

HAEMATOLOGICA (2021)

Article Hematology

Venetoclax combines synergistically with FLT3 inhibition to effectively target leukemic cells in FLT3-ITD+ acute myeloid leukemia models

Raghuveer Singh Mali et al.

Summary: The combination of FLT3-ITD inhibition with venetoclax demonstrates impressive anti-tumor activity in FLT3-ITD+ AML preclinical models, highlighting the strong mechanistic rationale for clinical studies.

HAEMATOLOGICA (2021)

Article Hematology

Flotetuzumab as salvage immunotherapy for refractory acute myeloid leukemia

Geoffrey L. Uy et al.

Summary: This study presents the results of a multicenter, open-label, phase 1/2 study of flotetuzumab in 88 adults with relapsed/refractory AML, showing clinical benefits in PIF/ER patients and encouraging evidence of activity. Flotetuzumab represents an innovative experimental approach associated with acceptable safety.
Article Hematology

Ivosidenib or enasidenib combined with intensive chemotherapy in patients with newly diagnosed AML: a phase 1 study

Eytan M. Stein et al.

Summary: Ivosidenib and enasidenib, as targeted oral inhibitors, demonstrated good safety and efficacy when combined with intensive chemotherapy in newly diagnosed mIDH1/2 AML patients, achieving end-of-induction complete remission rates of 55% and 47% respectively.
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Mutant Isocitrate Dehydrogenase 1 Inhibitor Ivosidenib in Combination With Azacitidine for Newly Diagnosed Acute Myeloid Leukemia

Courtney D. DiNardo et al.

Summary: The combination therapy of ivosidenib and azacitidine showed promising results in treating IDH1-mutant acute myeloid leukemia, with a well-tolerated safety profile and deep, durable responses observed in patients, especially those achieving complete remission and mIDH1 mutation clearance in bone marrow cells.

JOURNAL OF CLINICAL ONCOLOGY (2021)

Article Hematology

Clinical and molecular predictors of response and survival following venetoclax therapy in relapsed/refractory AML

Maximilian Stahl et al.

Summary: Combination therapy of venetoclax is effective in many patients with relapsed or refractory AML, with azacitidine+venetoclax showing higher response rates compared to low-dose cytarabine+venetoclax. Clinical and molecular characteristics of patients may predict treatment outcomes in this population.

BLOOD ADVANCES (2021)

Review Oncology

T-cell-based immunotherapy of acute myeloid leukemia: current concepts and future developments

Naval Daver et al.

Summary: AML is a heterogeneous disease with a broad spectrum of molecular abnormalities, requiring multiple therapeutic approaches for long-term disease control. Recent advancements in understanding and targeting these molecular aberrations have led to rapid evolution in AML treatment, with a focus on immunotherapies harnessing T cells. Multiple T-cell-based immunotherapies, including bispecific antibodies, CAR T-cell therapies, and immune checkpoint inhibitors, are in various stages of development for AML treatment.

LEUKEMIA (2021)

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Therapeutic Modulation of RNA Splicing in Malignant and Non-Malignant Disease

Ettaib El Marabti et al.

Summary: RNA splicing is a process where non-protein coding sequences are removed from RNA to produce mature protein-coding mRNA. Genetic alterations and changes in splicing factors can lead to various human genetic diseases and cancer. Therapies based on oligonucleotides and small molecules targeting splicing factors are currently being developed for different genetic disorders and cancer.

TRENDS IN MOLECULAR MEDICINE (2021)

Article Oncology

Splicing Patterns in SF3B1-Mutated Uveal Melanoma Generate Shared Immunogenic Tumor-Specific Neoepitopes

Jeremy Bigot et al.

Summary: Mutations in the splicing factor SF3B1 in uveal melanoma generate immunogenic neoantigens that can be recognized and killed by specific CD8(+) T cells, providing a potential new therapeutic target for tumors. These findings suggest that mutations in splicing factors may be a valuable source for developing novel therapeutic strategies for various types of cancers.

CANCER DISCOVERY (2021)

Review Hematology

Splicing factor mutations in hematologic malignancies

Sisi Chen et al.

Summary: Mutations in genes encoding RNA splicing factors are now known to play a key role in various blood disorders, leading to research on biological pathways disrupted by altered splicing and the development of new therapeutic approaches.
Article Hematology

Phase II study of azacitidine with pembrolizumab in patients with intermediate-1 or higher-risk myelodysplastic syndrome

Kelly S. Chien et al.

Summary: The study showed that PD-1 and PD-L1 expression is upregulated in CD34(+) bone marrow cells of MDS patients and combining azacitidine with pembrolizumab had a significant overall response rate of 76% in previously untreated patients. However, the combination therapy had a lower response rate in patients who had failed HMA treatment. Adverse events, such as pneumonia and arthralgias, were common, but manageable, with corticosteroids required in 43% of cases.

BRITISH JOURNAL OF HAEMATOLOGY (2021)

Article Oncology

A phase 1b/2 study of azacitidine with PD-L1 antibody avelumab in relapsed/refractory acute myeloid leukemia

Kapil Saxena et al.

Summary: Patients with relapsed/refractory acute myeloid leukemia (AML) have limited treatment options. The combination of azacitidine and the anti-PD-L1 immune checkpoint inhibitor avelumab showed limited clinical activity. High expression of PD-L2 on bone marrow blasts may contribute to resistance to anti-PD-L1 therapy in AML.

CANCER (2021)

Article Oncology

Outcomes of TP53-mutant acute myeloid leukemia with decitabine and venetoclax

Kunhwa Kim et al.

Summary: Patients with TP53(mut) AML show lower response rates and shorter survival when treated with DEC10-VEN compared to those with wild-type TP53 AML.

CANCER (2021)

Article Biochemistry & Molecular Biology

Pharmacologic modulation of RNA splicing enhances anti-tumor immunity

Sydney X. Lu et al.

Summary: The study demonstrates that modulation of splicing through specific drug classes generates genuine neoantigens and enhances anti-tumor immunity, augmenting checkpoint immunotherapy.
Article Oncology

Vorasidenib, a Dual Inhibitor of Mutant IDH1/2, in Recurrent or Progressive Glioma; Results of a First-in-Human Phase I Trial

Ingo K. Mellinghoff et al.

Summary: Vorasidenib demonstrated favorable safety profile and preliminary antitumor activity in patients with non-enhancing mIDH LGG, with a median progression-free survival of 36.8 months.

CLINICAL CANCER RESEARCH (2021)

Review Oncology

Maintenance therapies in acute myeloid leukemia: the renaissance of an old therapeutic concept

Jan Philipp Bewersdorf et al.

Summary: Recent research has shown that the oral hypomethylating agent CC-486 and FLT3 inhibitor sorafenib have demonstrated some maintenance efficacy in AML patients. There are still issues surrounding patient selection, timing, duration, and safety of maintenance therapies that need to be addressed.

CURRENT OPINION IN ONCOLOGY (2021)

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Venetoclax Combined With FLAG-IDA Induction and Consolidation in Newly Diagnosed and Relapsed or Refractory Acute Myeloid Leukemia

Courtney D. DiNardo et al.

Summary: The combination of fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin with venetoclax showed to be an effective treatment regimen in both newly diagnosed and relapsed or refractory AML patients, resulting in deep remissions and high rates of successful transplantation.

JOURNAL OF CLINICAL ONCOLOGY (2021)

Review Oncology

Therapeutic implications of menin inhibition in acute leukemias

Ghayas C. Issa et al.

Summary: Menin inhibitors are novel targeted agents currently being developed for the treatment of genetically defined subsets of acute leukemia, showing promising early results in specific leukemia types, such as NPM1 mutations. These inhibitors target various gene regulatory roles of menin in leukemogenesis and are being investigated in clinical studies for relapsed acute leukemias.

LEUKEMIA (2021)

Article Oncology

Phase I First-in-Human Dose Escalation Study of the oral SF3B1 modulator H3B-8800 in myeloid neoplasms

David P. Steensma et al.

Summary: H3B-8800 treatment was associated with mostly low-grade treatment-related adverse events and induced red blood cell transfusion independence in a subset of MDS patients.

LEUKEMIA (2021)

Article Oncology

Venetoclax-based combinations in AML and high-risk MDS prior to and following allogeneic hematopoietic cell transplant

Jan Philipp Bewersdorf et al.

Summary: The study found that using venetoclax as consolidation therapy before allo-HCT in AML or MDS patients can improve the 12-month survival rate, and venetoclax-based salvage therapy after allo-HCT can provide a potential salvage treatment option with a 12-month survival rate around 43.4%.

LEUKEMIA & LYMPHOMA (2021)

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Safety and Efficacy of Pembrolizumab Prior to Allogeneic Stem Cell Transplantation for Acute Myelogenous Leukemia

Nicholas P. Tschernia et al.

Summary: This study compared the clinical outcomes of AML patients receiving high-dose cytarabine followed by pembrolizumab prior to alloSCT with a historical control group. One-year survival did not significantly differ between the groups, but there was no 100-day mortality in the ICI group, and no increase in the severity of GVHD.

TRANSPLANTATION AND CELLULAR THERAPY (2021)

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A Therapeutic Strategy for Preferential Targeting of TET2-Mutant and TET Dioxygenase-Deficient Cells in Myeloid Neoplasms

Yihong Guan et al.

Summary: This study highlights the synthetic lethality between IDH1/2 mutations and TET dioxygenase deficiency. The TET-selective small-molecule inhibitor shows promising potential in restricting clonal evolution of TET2-mutant cells, indicating a new class of targeted agents for TET2-mutant neoplasms.

BLOOD CANCER DISCOVERY (2021)

Article Oncology

Targeting public neoantigens for cancer immunotherapy

Alexander H. Pearlman et al.

Summary: Immunotherapy can target public neoantigens for cancer treatment, which focuses on proteins crucial for tumor growth and can be applied to a broad range of patients. However, identifying suitable public neoantigen targets and developing corresponding therapeutic agents still pose challenges.

NATURE CANCER (2021)

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Epigenetic targeted therapy of stabilized BAP1 in ASXL1 gain-of-function mutated leukemia

Lu Wang et al.

Summary: The study uncovered gain-of-function mutations in ASXL1 that stabilize BAP1 protein and induce widespread epigenetic changes in myeloid neoplasms. By developing a chemical inhibitor targeting ASXL1-altered leukemia, the research provides a potential therapeutic strategy for this type of cancer. This breakthrough sheds light on the molecular mechanisms of ASXL1 mutations in leukemia pathogenesis and highlights small-molecular catalytic inhibitors of BAP1 as a promising targeted therapy.

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Menin inhibitor MI-3454 induces remission in MLL1-rearranged and NPM1-mutated models of leukemia

Szymon Klossowski et al.

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Justin A. Caravella et al.

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Jayakumar Vadakekolathu et al.

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CBFB-MYH11 fusion neoantigen enables T cell recognition and killing of acute myeloid leukemia

Melinda A. Biernacki et al.

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Marius Bill et al.

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CD123 bi-specific antibodies in development in AML: What do we know so far?

Michael J. Slade et al.

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CD33 directed bispecific antibodies in acute myeloid leukemia

Mary C. Clark et al.

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Immune signature drives leukemia escape and relapse after hematopoietic cell transplantation

Cristina Toffalori et al.

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Acute Myeloid Leukemia, Version 3.2019

Martin S. Tallman et al.

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Azacytidine Sensitizes AML Cells for Effective Elimination By CD123 CAR T-Cells

Nadia El Khawanky et al.

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Mutated nucleophosmin 1 as immunotherapy target in acute myeloid leukemia

Dyantha van der Lee et al.

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Stephen J. Schuster et al.

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The MLL recombinome of acute leukemias in 2017

C. Meyer et al.

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The emerging role of immune checkpoint based approaches in AML and MDS

Prajwal Boddu et al.

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Somatic mutations precede myeloid leukemia years before diagnosis

Pinkal Desai et al.

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Durable Remissions with Ivosidenib in IDH1-Mutated Relapsed or Refractory AML

C. D. DiNardo et al.

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Jae H. Park et al.

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Mutant ASXL1 cooperates with BAP1 to promote myeloid leukaemogenesis

Shuhei Asada et al.

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Acquired resistance to IDH inhibition through trans or cis dimer-interface mutations

Andrew M. Intlekofer et al.

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S. Jaiswal et al.

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Blinatumomab versus Chemotherapy for Advanced Acute Lymphoblastic Leukemia

Hagop Kantarjian et al.

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Zachary R. Chalmers et al.

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Genomic Classification and Prognosis in Acute Myeloid Leukemia

Elli Papaemmanuil et al.

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Isocitrate dehydrogenase 1 and 2 mutations induce BCL-2 dependence in acute myeloid leukemia

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Cancer-associated ASXL1 mutations may act as gain-of-function mutations of the ASXL1-BAP1 complex

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Clonal Hematopoiesis and Blood-Cancer Risk Inferred from Blood DNA Sequence

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Age-Related Clonal Hematopoiesis Associated with Adverse Outcomes

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Genomic and Epigenomic Landscapes of Adult De Novo Acute Myeloid Leukemia

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Recurrent somatic TET2 mutations in normal elderly individuals with clonal hematopoiesis

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