Biological and therapeutic implications of a unique subtype of NPM1 mutated AML

Nat Commun. 2021 Feb 16;12(1):1054. doi: 10.1038/s41467-021-21233-0.

Abstract

In acute myeloid leukemia (AML), molecular heterogeneity across patients constitutes a major challenge for prognosis and therapy. AML with NPM1 mutation is a distinct genetic entity in the revised World Health Organization classification. However, differing patterns of co-mutation and response to therapy within this group necessitate further stratification. Here we report two distinct subtypes within NPM1 mutated AML patients, which we label as primitive and committed based on the respective presence or absence of a stem cell signature. Using gene expression (RNA-seq), epigenomic (ATAC-seq) and immunophenotyping (CyToF) analysis, we associate each subtype with specific molecular characteristics, disease differentiation state and patient survival. Using ex vivo drug sensitivity profiling, we show a differential drug response of the subtypes to specific kinase inhibitors, irrespective of the FLT3-ITD status. Differential drug responses of the primitive and committed subtype are validated in an independent AML cohort. Our results highlight heterogeneity among NPM1 mutated AML patient samples based on stemness and suggest that the addition of kinase inhibitors to the treatment of cases with the primitive signature, lacking FLT3-ITD, could have therapeutic benefit.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Chromatin / metabolism
  • Cluster Analysis
  • Gene Expression Regulation, Leukemic / drug effects
  • Humans
  • Immunophenotyping
  • Leukemia, Myeloid, Acute / drug therapy*
  • Leukemia, Myeloid, Acute / genetics*
  • Mutation / genetics*
  • Nuclear Proteins / genetics*
  • Nucleophosmin
  • Phenotype
  • Protein Kinase Inhibitors / pharmacology
  • Protein Kinase Inhibitors / therapeutic use
  • Reproducibility of Results
  • Survival Analysis

Substances

  • Chromatin
  • NPM1 protein, human
  • Nuclear Proteins
  • Protein Kinase Inhibitors
  • Nucleophosmin

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