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Immune landscapes predict chemotherapy resistance and immunotherapy response in acute myeloid leukemia.

ABSTRACT: Acute myeloid leukemia (AML) is a molecularly and clinically heterogeneous hematological malignancy. Although immunotherapy may be an attractive modality to exploit in patients with AML, the ability to predict the groups of patients and the types of cancer that will respond to immune targeting remains limited. This study dissected the complexity of the immune architecture of AML at high resolution and assessed its influence on therapeutic response. Using 442 primary bone marrow samples from three independent cohorts of children and adults with AML, we defined immune-infiltrated and immune-depleted disease classes and revealed critical differences in immune gene expression across age groups and molecular disease subtypes. Interferon (IFN)-γ-related mRNA profiles were predictive for both chemotherapy resistance and response of primary refractory/relapsed AML to flotetuzumab immunotherapy. Our compendium of microenvironmental gene and protein profiles provides insights into the immuno-biology of AML and could inform the delivery of personalized immunotherapies to IFN-γ-dominant AML subtypes.

SUBMITTER: Vadakekolathu J

PROVIDER: S-EPMC7427158 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Immune landscapes predict chemotherapy resistance and immunotherapy response in acute myeloid leukemia.

Vadakekolathu Jayakumar J Minden Mark D MD Hood Tressa T Church Sarah E SE Reeder Stephen S Altmann Heidi H Sullivan Amy H AH Viboch Elena J EJ Patel Tasleema T Ibrahimova Narmin N Warren Sarah E SE Arruda Andrea A Liang Yan Y Smith Thomas H TH Foulds Gemma A GA Bailey Michael D MD Gowen-MacDonald James J Muth John J Schmitz Marc M Cesano Alessandra A Pockley A Graham AG Valk Peter J M PJM Löwenberg Bob B Bornhäuser Martin M Tasian Sarah K SK Rettig Michael P MP Davidson-Moncada Jan K JK DiPersio John F JF Rutella Sergio S

Science translational medicine 20200601 546

Acute myeloid leukemia (AML) is a molecularly and clinically heterogeneous hematological malignancy. Although immunotherapy may be an attractive modality to exploit in patients with AML, the ability to predict the groups of patients and the types of cancer that will respond to immune targeting remains limited. This study dissected the complexity of the immune architecture of AML at high resolution and assessed its influence on therapeutic response. Using 442 primary bone marrow samples from thre ...[more]

PMID: 32493790

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Project description:BackgroundThe immune response in the bone marrow microenvironment has implications for progression and prognosis in acute myeloid leukemia (AML). However, few immune-related biomarkers for AML prognosis and immunotherapy response have been identified. We aimed to establish a predictive gene signature and to explore the determinants of prognosis in AML.MethodsImmune-related genes with clinical significance were screened by a weighted gene co-expression network analysis. Seven immune-related genes were used to establish a gene signature by a multivariate Cox regression analysis. Based on the signature, low- and high-risk groups were compared with respect to the immune microenvironment, immune checkpoints, pathway activities, and mutation frequencies. The tumor immune dysfunction and exclusion (TIDE) method was used to predict the response to immune checkpoint blockade (ICB) therapy. The Connectivity Map database was used to explore small-molecule drugs expected to treat high-risk populations.ResultsA seven-gene prognostic signature was used to classify patients into high- and low-risk groups. Prognosis was poorer for patients in the former than in the latter. The high-risk group displayed higher levels of immune checkpoint molecules (LAG3, PD-1, CTLA4, PD-L2, and PD-L1), immune cell infiltration (dendritic cells, T helper 1, and gamma delta T), and somatic mutations (NPM1 and RUNX1). Moreover, hematopoietic stem cell/leukemia stem cell pathways were enriched in the high-risk phenotype. Compared with that in the low-risk group, the lower TIDE score for the high-risk group implied that this group is more likely to benefit from ICB therapy. Finally, some drugs (FLT3 inhibitors and BCL inhibitors) targeting the expression profiles associated with the high-risk group were generated using Connectivity Map.ConclusionThe newly developed immune-related gene signature is an effective biomarker for predicting prognosis in AML and provides a basis, from an immunological perspective, for the development of comprehensive therapeutic strategies.

Project description:IntroductionNumerous studies have demonstrated acute myeloid leukemia (AML) is one of the malignancies with high mortality worldwide. Immunogenic cell death (ICD) is a form of cell death that is specialised in that it triggers the body's immune response, particularly the adaptive immune response. Recent evidence has confirmed that pseudogenes are implicated in multiple human tumorigenesis and progression although lacking the function of coding protein. However, the roles of ICD-associated genes in AML remain largely unascertained.MethodsTCGA-AML and GSE71014 cohorts were picked out and we combined them into a merged dataset by removing the batch effect using the sva package in the R project. A consensus clustering analysis of the ICD genes in AML was performed to define subgroups. Based on the expression of 15 prognostic-related pseudogenes, we developed a prognostic model and categorized AML samples into low and high-risk groups.ResultsAML was differentiated into two subgroups (C1 and C2 clusters). Most ICD-related genes were significantly up-regulated in the C2 cluster. The single sample gene set enrichment analysis (ssGSEA) revealed that the immune cell infiltration and immune checkpoint gene expression of the C2 cluster was strongly high, suggesting that the C2 population responded well to immune checkpoint blockade (ICB) therapy and had better survival. The C1 group was sensitive to chemotherapy, including Cytarabine, Midostaurin, and Doxorubicin. On the other hand, 15 ICD-related pseudogenes were identified to be associated with AML prognosis. The receiver operator curve (ROC) analysis and nomogram manifested that our prognostic model had high accuracy in predicting survival. However, the high-risk group was sensitive to ICB therapy and chemotherapy such as Methotrexate, Cytarabine, and Axitinib while the low-risk group benefited from 5-Fluorouracil, Talazoparib, and Navitoclax therapy.DiscussionIn summary, we defined two subgroups relying on 33 ICD-related genes and this classification exerted a decisive role in assessing immunotherapy and chemotherapy benefit. Significantly, a prognostic signature identified by critical ICD-related pseudogene was created. The pseudogene prognostic signature had a powerful performance in predicting prognosis and therapeutic efficacy, including immunotherapy and chemotherapy to AML. Our research points out novel implications of ICD in cancer prognosis and treatment approach choice.

Dataset Information

Immune landscapes predict chemotherapy resistance and immunotherapy response in acute myeloid leukemia.

Publications

Immune landscapes predict chemotherapy resistance and immunotherapy response in acute myeloid leukemia.

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