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Blood, 15 April 2001, Vol. 97, No. 8, pp. 2434-2439

NEOPLASIA

Activating mutation of D835 within the activation loop of FLT3 in human hematologic malignancies

Yukiya Yamamoto, Hitoshi Kiyoi, Yasuyuki Nakano, Ritsuro Suzuki, Yoshihisa Kodera, Shuichi Miyawaki, Norio Asou, Kazutaka Kuriyama, Fumiharu Yagasaki, Chihiro Shimazaki, Hideki Akiyama, Kenji Saito, Miki Nishimura, Toshiko Motoji, Katsuji Shinagawa, Akihiro Takeshita, Hidehiko Saito, Ryuzo Ueda, Ryuzo Ohno, and Tomoki Naoe

From the Department of Infectious Diseases and the First Department of Internal Medicine, Nagoya University School of Medicine; Division of Molecular Medicine, Aichi Cancer Center; the Department of Medicine, Japanese Red Cross Nagoya First Hospital; Second Department of Internal Medicine, Nagoya City University School of Medicine, Nagoya, Japan; Department of Medicine, Saiseikai Maebashi Hospital, Maebashi, Japan; Second Department of Internal Medicine, Kumamoto University School of Medicine, Kumamoto, Japan; Department of Hematology, Atomic Disease Institute, Nagasaki University School of Medicine, Nagasaki, Japan; First Department of Internal Medicine, Saitama Medical School, Saitama, Japan; Second Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Hematology, Tokyo Metropolitan Komagome Hospital; Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan; Department of Hematology, Dokkyo University School of Medicine, Tochigi, Japan; Second Department of Internal Medicine, Chiba University School of Medicine, Chiba, Japan; Second Department of Medicine, Okayama University School of Medicine, Okayama, Japan; and Department of Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan.

Mutations of receptor tyrosine kinases are implicated in the constitutive activation and development of human malignancy. An internal tandem duplication (ITD) of the juxtamembrane (JM) domain-coding sequence of the FLT3 gene (FLT3/ITD) is found in 20% of patients with acute myeloid leukemia (AML) and is strongly associated with leukocytosis and a poor prognosis. On the other hand, mutations of the c-KIT gene, which have been found in mast cell leukemia and AML, are clustered in 2 distinct regions, the JM domain and D816 within the activation loop. This study was designed to analyze the mutation of D835 of FLT3, which corresponds to D816 of c-KIT, in a large series of human hematologic malignancies. Several kinds of missense mutations were found in 30 of the 429 (7.0%) AML cases, 1 of the 29 (3.4%) myelodysplastic syndrome (MDS) cases, and 1 of the 36 (2.8%) acute lymphocytic leukemia patients. The D835Y mutation was most frequently found (22 of the 32 D835 mutations), followed by the D835V (5), and D835H (1), D835E (1), and D835N (1) mutations. Of note is that D835 mutations occurred independently of FLT3/ITD. An analysis in the 201 patients newly diagnosed with AML (excluding M3) revealed that, in contrast to the FLT3/ITD mutation (n = 46), D835 mutations (n = 8) were not significantly related to the leukocytosis, but tended to worsen disease-free survival. All D835-mutant FLT3 were constitutively tyrosine-phosphorylated and transformed 32D cells, suggesting these mutations were constitutively active. These results demonstrate that the FLT3 gene is the target most frequently mutated to become constitutively active in AML.

© 2001 by The American Society of Hematology.
 

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IMC-EB10, an Anti-FLT3 Monoclonal Antibody, Prolongs Survival and Reduces Nonobese Diabetic/Severe Combined Immunodeficient Engraftment of Some Acute Lymphoblastic Leukemia Cell Lines and Primary Leukemic Samples.
Cancer Res., May 1, 2006; 66(9): 4843 - 4851.
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BloodHome page
D. L. Stirewalt, K. J. Kopecky, S. Meshinchi, J. H. Engel, E. L. Pogosova-Agadjanyan, J. Linsley, M. L. Slovak, C. L. Willman, and J. P. Radich
Size of FLT3 internal tandem duplication has prognostic significance in patients with acute myeloid leukemia
Blood, May 1, 2006; 107(9): 3724 - 3726.
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BloodHome page
R. Cairoli, A. Beghini, G. Grillo, G. Nadali, F. Elice, C. B. Ripamonti, P. Colapietro, M. Nichelatti, L. Pezzetti, M. Lunghi, et al.
Prognostic impact of c-KIT mutations in core binding factor leukemias: an Italian retrospective study
Blood, May 1, 2006; 107(9): 3463 - 3468.
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C. Reindl, K. Bagrintseva, S. Vempati, S. Schnittger, J. W. Ellwart, K. Wenig, K.-P. Hopfner, W. Hiddemann, and K. Spiekermann
Point mutations in the juxtamembrane domain of FLT3 define a new class of activating mutations in AML
Blood, May 1, 2006; 107(9): 3700 - 3707.
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BloodHome page
A. Shimada, T. Taki, K. Tabuchi, A. Tawa, K. Horibe, M. Tsuchida, R. Hanada, I. Tsukimoto, and Y. Hayashi
KIT mutations, and not FLT3 internal tandem duplication, are strongly associated with a poor prognosis in pediatric acute myeloid leukemia with t(8;21): a study of the Japanese Childhood AML Cooperative Study Group
Blood, March 1, 2006; 107(5): 1806 - 1809.
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JEMHome page
H. S. Radomska, D. S. Basseres, R. Zheng, P. Zhang, T. Dayaram, Y. Yamamoto, D. W. Sternberg, N. Lokker, N. A. Giese, S. K. Bohlander, et al.
Block of C/EBP{alpha} function by phosphorylation in acute myeloid leukemia with FLT3 activating mutations
J. Exp. Med., February 21, 2006; 203(2): 371 - 381.
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ASH Education BookHome page
D. Small
FLT3 Mutations: Biology and Treatment
Hematology, January 1, 2006; 2006(1): 178 - 184.
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BloodHome page
F. Heidel, F. K. Solem, F. Breitenbuecher, D. B. Lipka, S. Kasper, M. H. Thiede, C. Brandts, H. Serve, J. Roesel, F. Giles, et al.
Clinical resistance to the kinase inhibitor PKC412 in acute myeloid leukemia by mutation of Asn-676 in the FLT3 tyrosine kinase domain
Blood, January 1, 2006; 107(1): 293 - 300.
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Proc. Natl. Acad. Sci. USAHome page
X. Lu, R. Levine, W. Tong, G. Wernig, Y. Pikman, S. Zarnegar, D. G. Gilliland, and H. Lodish
Expression of a homodimeric type I cytokine receptor is required for JAK2V617F-mediated transformation
PNAS, December 27, 2005; 102(52): 18962 - 18967.
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BloodHome page
P. Van Vlierberghe, J. P. P. Meijerink, R. W. Stam, W. van der Smissen, E. R. van Wering, H. B. Beverloo, and R. Pieters
Activating FLT3 mutations in CD4+/CD8- pediatric T-cell acute lymphoblastic leukemias
Blood, December 15, 2005; 106(13): 4414 - 4415.
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BloodHome page
R. E. Gale, R. Hills, A. R. Pizzey, P. D. Kottaridis, D. Swirsky, A. F. Gilkes, E. Nugent, K. I. Mills, K. Wheatley, E. Solomon, et al.
Relationship between FLT3 mutation status, biologic characteristics, and response to targeted therapy in acute promyelocytic leukemia
Blood, December 1, 2005; 106(12): 3768 - 3776.
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Cancer Res.Home page
C. H. Brandts, B. Sargin, M. Rode, C. Biermann, B. Lindtner, J. Schwable, H. Buerger, C. Muller-Tidow, C. Choudhary, M. McMahon, et al.
Constitutive Activation of Akt by Flt3 Internal Tandem Duplications Is Necessary for Increased Survival, Proliferation, and Myeloid Transformation
Cancer Res., November 1, 2005; 65(21): 9643 - 9650.
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BloodHome page
T. Suzuki, H. Kiyoi, K. Ozeki, A. Tomita, S. Yamaji, R. Suzuki, Y. Kodera, S. Miyawaki, N. Asou, K. Kuriyama, et al.
Clinical characteristics and prognostic implications of NPM1 mutations in acute myeloid leukemia
Blood, October 15, 2005; 106(8): 2854 - 2861.
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BloodHome page
R. W. Stam, M. L. den Boer, P. Schneider, P. Nollau, M. Horstmann, H. B. Beverloo, E. van der Voort, M. G. Valsecchi, P. de Lorenzo, S. E. Sallan, et al.
Targeting FLT3 in primary MLL-gene-rearranged infant acute lymphoblastic leukemia
Blood, October 1, 2005; 106(7): 2484 - 2490.
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D. T. Bowen, M. E. Frew, R. Hills, R. E. Gale, K. Wheatley, M. J. Groves, S. E. Langabeer, P. D. Kottaridis, A. V. Moorman, A. K. Burnett, et al.
RAS mutation in acute myeloid leukemia is associated with distinct cytogenetic subgroups but does not influence outcome in patients younger than 60 years
Blood, September 15, 2005; 106(6): 2113 - 2119.
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JCOHome page
S. Frohling, C. Scholl, D. G. Gilliland, and R. L. Levine
Genetics of Myeloid Malignancies: Pathogenetic and Clinical Implications
J. Clin. Oncol., September 10, 2005; 23(26): 6285 - 6295.
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Cancer Res.Home page
X. Yang, L. Liu, D. Sternberg, L. Tang, I. Galinsky, D. DeAngelo, and R. Stone
The FLT3 Internal Tandem Duplication Mutation Prevents Apoptosis in Interleukin-3-Deprived BaF3 Cells Due to Protein Kinase A and Ribosomal S6 Kinase 1-Mediated BAD Phosphorylation at Serine 112
Cancer Res., August 15, 2005; 65(16): 7338 - 7347.
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D. E. Lopes de Menezes, J. Peng, E. N. Garrett, S. G. Louie, S. H. Lee, M. Wiesmann, Y. Tang, L. Shephard, C. Goldbeck, Y. Oei, et al.
CHIR-258: A Potent Inhibitor of FLT3 Kinase in Experimental Tumor Xenograft Models of Human Acute Myelogenous Leukemia
Clin. Cancer Res., July 15, 2005; 11(14): 5281 - 5291.
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NEJMHome page
D. S. Krause and R. A. Van Etten
Tyrosine Kinases as Targets for Cancer Therapy
N. Engl. J. Med., July 14, 2005; 353(2): 172 - 187.
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C. Choudhary, J. Schwable, C. Brandts, L. Tickenbrock, B. Sargin, T. Kindler, T. Fischer, W. E. Berdel, C. Muller-Tidow, and H. Serve
AML-associated Flt3 kinase domain mutations show signal transduction differences compared with Flt3 ITD mutations
Blood, July 1, 2005; 106(1): 265 - 273.
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BloodHome page
R. Grundler, C. Miething, C. Thiede, C. Peschel, and J. Duyster
FLT3-ITD and tyrosine kinase domain mutants induce 2 distinct phenotypes in a murine bone marrow transplantation model
Blood, June 15, 2005; 105(12): 4792 - 4799.
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BloodHome page
K. Bagrintseva, S. Geisenhof, R. Kern, S. Eichenlaub, C. Reindl, J. W. Ellwart, W. Hiddemann, and K. Spiekermann
FLT3-ITD-TKD dual mutants associated with AML confer resistance to FLT3 PTK inhibitors and cytotoxic agents by overexpression of Bcl-x(L)
Blood, May 1, 2005; 105(9): 3679 - 3685.
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BloodHome page
L. Tickenbrock, J. Schwable, M. Wiedehage, B. Steffen, B. Sargin, C. Choudhary, C. Brandts, W. E. Berdel, C. Muller-Tidow, and H. Serve
Flt3 tandem duplication mutations cooperate with Wnt signaling in leukemic signal transduction
Blood, May 1, 2005; 105(9): 3699 - 3706.
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BloodHome page
D. K. Walters, E. P. Stoffregen, M. C. Heinrich, M. W. Deininger, and B. J. Druker
RNAi-induced down-regulation of FLT3 expression in AML cell lines increases sensitivity to MLN518
Blood, April 1, 2005; 105(7): 2952 - 2954.
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BloodHome page
C. Recher, O. Beyne-Rauzy, C. Demur, G. Chicanne, C. Dos Santos, V. M.-D. Mas, D. Benzaquen, G. Laurent, F. Huguet, and B. Payrastre
Antileukemic activity of rapamycin in acute myeloid leukemia
Blood, March 15, 2005; 105(6): 2527 - 2534.
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BloodHome page
J. Schwable, C. Choudhary, C. Thiede, L. Tickenbrock, B. Sargin, C. Steur, M. Rehage, A. Rudat, C. Brandts, W. E. Berdel, et al.
RGS2 is an important target gene of Flt3-ITD mutations in AML and functions in myeloid differentiation and leukemic transformation
Blood, March 1, 2005; 105(5): 2107 - 2114.
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J. Biol. Chem.Home page
P. Chen, M. Levis, P. Brown, K.-T. Kim, J. Allebach, and D. Small
FLT3/ITD Mutation Signaling Includes Suppression of SHP-1
J. Biol. Chem., February 18, 2005; 280(7): 5361 - 5369.
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Cancer Res.Home page
O. Piloto, M. Levis, D. Huso, Y. Li, H. Li, M.-N. Wang, R. Bassi, P. Balderes, D. L. Ludwig, L. Witte, et al.
Inhibitory Anti-FLT3 Antibodies Are Capable of Mediating Antibody-Dependent Cell-Mediated Cytotoxicity and Reducing Engraftment of Acute Myelogenous Leukemia Blasts in Nonobese Diabetic/Severe Combined Immunodeficient Mice
Cancer Res., February 15, 2005; 65(4): 1514 - 1522.
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BloodHome page
W. Fiedler, H. Serve, H. Dohner, M. Schwittay, O. G. Ottmann, A.-M. O'Farrell, C. L. Bello, R. Allred, W. C. Manning, J. M. Cherrington, et al.
A phase 1 study of SU11248 in the treatment of patients with refractory or resistant acute myeloid leukemia (AML) or not amenable to conventional therapy for the disease
Blood, February 1, 2005; 105(3): 986 - 993.
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BloodHome page
P. Brown, M. Levis, S. Shurtleff, D. Campana, J. Downing, and D. Small
FLT3 inhibition selectively kills childhood acute lymphoblastic leukemia cells with high levels of FLT3 expression
Blood, January 15, 2005; 105(2): 812 - 820.
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BloodHome page
M. Wadleigh, D. J. DeAngelo, J. D. Griffin, and R. M. Stone
After chronic myelogenous leukemia: tyrosine kinase inhibitors in other hematologic malignancies
Blood, January 1, 2005; 105(1): 22 - 30.
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BloodHome page
R. M. Stone, D. J. DeAngelo, V. Klimek, I. Galinsky, E. Estey, S. D. Nimer, W. Grandin, D. Lebwohl, Y. Wang, P. Cohen, et al.
Patients with acute myeloid leukemia and an activating mutation in FLT3 respond to a small-molecule FLT3 tyrosine kinase inhibitor, PKC412
Blood, January 1, 2005; 105(1): 54 - 60.
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BloodHome page
K. Y. Chung, G. Morrone, J. J. Schuringa, B. Wong, D. C. Dorn, and M. A. S. Moore
Enforced expression of an Flt3 internal tandem duplication in human CD34+ cells confers properties of self-renewal and enhanced erythropoiesis
Blood, January 1, 2005; 105(1): 77 - 84.
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T. Kindler, F. Breitenbuecher, S. Kasper, E. Estey, F. Giles, E. Feldman, G. Ehninger, G. Schiller, V. Klimek, S. D. Nimer, et al.
Identification of a novel activating mutation (Y842C) within the activation loop of FLT3 in patients with acute myeloid leukemia (AML)
Blood, January 1, 2005; 105(1): 335 - 340.
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BloodHome page
K. W. H. Yee, M. Schittenhelm, A.-M. O'Farrell, A. R. Town, L. McGreevey, T. Bainbridge, J. M. Cherrington, and M. C. Heinrich
Synergistic effect of SU11248 with cytarabine or daunorubicin on FLT3 ITD-positive leukemic cells
Blood, December 15, 2004; 104(13): 4202 - 4209.
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BloodHome page
J. J. Clark, J. Cools, D. P. Curley, J.-C. Yu, N. A. Lokker, N. A. Giese, and D. G. Gilliland
Variable sensitivity of FLT3 activation loop mutations to the small molecule tyrosine kinase inhibitor MLN518
Blood, November 1, 2004; 104(9): 2867 - 2872.
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F. Chiara, M.-J. Goumans, H. Forsberg, A. Ahgren, A. Rasola, P. Aspenstrom, C. Wernstedt, C. Hellberg, C.-H. Heldin, and R. Heuchel
A Gain of Function Mutation in the Activation Loop of Plateletderived Growth Factor {beta}-Receptor Deregulates Its Kinase Activity
J. Biol. Chem., October 8, 2004; 279(41): 42516 - 42527.
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P. Brown, S. Meshinchi, M. Levis, T. A. Alonzo, R. Gerbing, B. Lange, R. Arceci, and D. Small
Pediatric AML primary samples with FLT3/ITD mutations are preferentially killed by FLT3 inhibition
Blood, September 15, 2004; 104(6): 1841 - 1849.
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BloodHome page
J. Jiang, J. G. Paez, J. C. Lee, R. Bo, R. M. Stone, D. J. DeAngelo, I. Galinsky, B. M. Wolpin, A. Jonasova, P. Herman, et al.
Identifying and characterizing a novel activating mutation of the FLT3 tyrosine kinase in AML
Blood, September 15, 2004; 104(6): 1855 - 1858.
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Y. Li, H. Li, M.-N. Wang, D. Lu, R. Bassi, Y. Wu, H. Zhang, P. Balderes, D. L. Ludwig, B. Pytowski, et al.
Suppression of leukemia expressing wild-type or ITD-mutant FLT3 receptor by a fully human anti-FLT3 neutralizing antibody
Blood, August 15, 2004; 104(4): 1137 - 1144.
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BloodHome page
M. Levis, R. Pham, B. D. Smith, and D. Small
In vitro studies of a FLT3 inhibitor combined with chemotherapy: sequence of administration is important to achieve synergistic cytotoxic effects
Blood, August 15, 2004; 104(4): 1145 - 1150.
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J. Mol. Diagn.Home page
R. Luthra and L. J. Medeiros
Isothermal Multiple Displacement Amplification: A Highly Reliable Approach for Generating Unlimited High Molecular Weight Genomic DNA from Clinical Specimens
J. Mol. Diagn., August 1, 2004; 6(3): 236 - 242.
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BloodHome page
J. Chen, I. R. Williams, J. L. Kutok, N. Duclos, E. Anastasiadou, S. C. Masters, H. Fu, and D. G. Gilliland
Positive and negative regulatory roles of the WW-like domain in TEL-PDGF{beta}R transformation
Blood, July 15, 2004; 104(2): 535 - 542.
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BloodHome page
E. J. C. Rombouts, B. Pavic, B. Lowenberg, and R. E. Ploemacher
Relation between CXCR-4 expression, Flt3 mutations, and unfavorable prognosis of adult acute myeloid leukemia
Blood, July 15, 2004; 104(2): 550 - 557.
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BloodHome page
E. Paietta, A. A. Ferrando, D. Neuberg, J. M. Bennett, J. Racevskis, H. Lazarus, G. Dewald, J. M. Rowe, P. H. Wiernik, M. S. Tallman, et al.
Activating FLT3 mutations in CD117/KIT+ T-cell acute lymphoblastic leukemias
Blood, July 15, 2004; 104(2): 558 - 560.
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