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Prepublished online as a Blood First Edition Paper on December 19, 2002; DOI 10.1182/blood-2002-06-1800.

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2002-06-1800v1
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Blood, 15 April 2003, Vol. 101, No. 8, pp. 3188-3197

NEOPLASIA

A model of APL with FLT3 mutation is responsive to retinoic acid and a receptor tyrosine kinase inhibitor, SU11657

Jastinder Sohal, Vernon T. Phan, Philip V. Chan, Elizabeth M. Davis, Bhumi Patel, Louise M. Kelly, Tinya J. Abrams, Anne Marie O'Farrell, D. Gary Gilliland, Michelle M. Le Beau, and Scott C. Kogan

From the Comprehensive Cancer Center and the Department of Laboratory Medicine, University of California, San Francisco; Section of Hematology/Oncology, University of Chicago, IL; Division of Hematology/Oncology, Brigham and Women's Hospital and Howard Hughes Medical Institute, Harvard Medical School, Boston, MA; and Sugen Inc, South San Francisco, CA.

The PML-RARalpha fusion protein is central to the pathogenesis of acute promyelocytic leukemia (APL). Expression of this protein in transgenic mice initiates myeloid leukemias with features of human APL, but only after a long latency (8.5 months in MRP8 PML-RARA mice). Thus, additional changes contribute to leukemic transformation. Activating mutations of the FLT3 receptor tyrosine kinase are common in human acute myeloid leukemias and are frequent in human APL. To assess how activating mutations of FLT3 contribute to APL pathogenesis and impact therapy, we used retroviral transduction to introduce an activated allele of FLT3 into control and MRP8 PML-RARA transgenic bone marrow. Activated FLT3 cooperated with PML-RARalpha to induce leukemias in 62 to 299 days (median latency, 105 days). In contrast to the leukemias that arose spontaneously in MRP8 PML-RARA mice, the activated FLT3/PML-RARalpha leukemias were characterized by leukocytosis, similar to human APL with FLT3 mutations. Cytogenetic analysis revealed clonal karyotypic abnormalities, which may contribute to pathogenesis or progression. SU11657, a selective, oral, multitargeted tyrosine kinase inhibitor that targets FLT3, cooperated with all-trans retinoic acid to rapidly cause regression of leukemia. Our results suggest that the acquisition of FLT3 mutations by cells with a pre-existing t(15;17) is a frequent pathway to the development of APL. Our findings also indicate that APL patients with FLT3 mutations may benefit from combination therapy with all-trans retinoic acid plus an FLT3 inhibitor.

© 2003 by The American Society of Hematology.
 

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