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Biallelic TET2 mutations confer sensitivity to 5'-azacitidine in acute myeloid leukemia.


ABSTRACT: Precision medicine can significantly improve outcomes for patients with cancer, but implementation requires comprehensive characterization of tumor cells to identify therapeutically exploitable vulnerabilities. Here, we describe somatic biallelic TET2 mutations in an elderly patient with acute myeloid leukemia (AML) that was chemoresistant to anthracycline and cytarabine but acutely sensitive to 5'-azacitidine (5'-Aza) hypomethylating monotherapy, resulting in long-term morphological remission. Given the role of TET2 as a regulator of genomic methylation, we hypothesized that mutant TET2 allele dosage affects response to 5'-Aza. Using an isogenic cell model system and an orthotopic mouse xenograft, we demonstrate that biallelic TET2 mutations confer sensitivity to 5'-Aza compared with cells with monoallelic mutations. Our data argue in favor of using hypomethylating agents for chemoresistant disease or as first-line therapy in patients with biallelic TET2-mutated AML and demonstrate the importance of considering mutant allele dosage in the implementation of precision medicine for patients with cancer.

SUBMITTER: Stolzel F 

PROVIDER: S-EPMC9977313 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

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Biallelic TET2 mutations confer sensitivity to 5'-azacitidine in acute myeloid leukemia.

Stölzel Friedrich F   Fordham Sarah E SE   Nandana Devi D   Lin Wei-Yu WY   Blair Helen H   Elstob Claire C   Bell Hayden L HL   Mohr Brigitte B   Ruhnke Leo L   Kunadt Desiree D   Dill Claudia C   Allsop Daniel D   Piddock Rachel R   Soura Emmanouela-Niki EN   Park Catherine C   Fadly Mohd M   Rahman Thahira T   Alharbi Abrar A   Wobus Manja M   Altmann Heidi H   Röllig Christoph C   Wagenführ Lisa L   Jones Gail L GL   Menne Tobias T   Jackson Graham H GH   Marr Helen J HJ   Fitzgibbon Jude J   Onel Kenan K   Meggendorfer Manja M   Robinson Amber A   Bziuk Zuzanna Z   Bowes Emily E   Heidenreich Olaf O   Haferlach Torsten T   Villar Sara S   Ariceta Beñat B   Diaz Rosa Ayala RA   Altschuler Steven J SJ   Wu Lani F LF   Prosper Felipe F   Montesinos Pau P   Martinez-Lopez Joaquin J   Bornhäuser Martin M   Allan James M JM  

JCI insight 20230124 2


Precision medicine can significantly improve outcomes for patients with cancer, but implementation requires comprehensive characterization of tumor cells to identify therapeutically exploitable vulnerabilities. Here, we describe somatic biallelic TET2 mutations in an elderly patient with acute myeloid leukemia (AML) that was chemoresistant to anthracycline and cytarabine but acutely sensitive to 5'-azacitidine (5'-Aza) hypomethylating monotherapy, resulting in long-term morphological remission.  ...[more]

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