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Blood, 15 September 2007, Vol. 110, No. 6, pp. 2057-2066.
Prepublished online as a Blood First Edition Paper on May 29, 2007; DOI 10.1182/blood-2007-03-080325.
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Submitted March 15, 2007
Accepted May 18, 2007
Activity of vincristine, L-ASP, and dexamethasone against acute lymphoblastic leukemia is enhanced by the BH3-mimetic ABT-737 in vitro and in vivo
Min H. Kang*, Yun Hee Kang, Barbara Szymanska, Urszula Wilczynska-Kalak, Michael A. Sheard, Theresa Harned, Richard B. Lock, and C. Patrick Reynolds
Developmental Therapeutics Program, USC-CHLA Institute for Pediatric Clinical Research, Childrens Hospital Los Angeles & USC, Los Angeles, CA, United States
Children's Cancer Instutute Australia for Medical Research, University of New South Wales, Sydney, Australia
* Corresponding author; email: mkang{at}chla.usc.edu.
Defects in apoptosis signaling contribute to poor outcome in pediatric acute lymphoblastic leukemia (ALL), and overexpression of anti-apoptotic Bcl-2 (Bcl-2 and Bcl-XL) family proteins has been observed in ALL. ABT-737 is a small molecule BH3-mimetic that inhibits the anti-apoptotic Bcl-2 family proteins. We evaluated the cytotoxicity of ABT-737 in combination with vincristine, dexamethasone, and L-asparaginase (VXL) in 7 ALL cell lines. Multi-log synergistic cytotoxicity was observed in all 7 cell lines with ABT-737 plus L-ASP or vincristine, and in 5 of 7 with ABT-737 plus dexamethasone or VXL. In leukemia cells, but not in normal lymphocytes, ABT-737 plus L-ASP induced greater mitochondrial depolarization (JC-1 staining), mitochondrial cytochrome c release, activation of Bax, Bid, and caspases (immunoblotting), and eventually apoptosis (annexin V staining), than did either drug alone. In mouse xenografts derived from ALL patients at diagnosis (ALL-7) or at relapse (ALL-19), event-free survival (EFS) was significantly enhanced with ABT-737 plus VXL relative to VXL or ABT-737 alone (P 0.02). Thus, ABT-737 synergistically enhanced VXL cytotoxicity in ALL cell lines via a mitochondrial death pathway and enhanced EFS in VXL-treated mice bearing ALL xenografts. Combining VXL with a BH3-mimetic warrants clinical investigation in ALL at relapse and potentially in chemotherapy-resistant ALL subgroups.

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