Response of high-risk MDS to azacitidine and lenalidomide is impacted by baseline and acquired mutations in a cluster of three inositide-specific genes.

Abstract:

:Specific myeloid-related and inositide-specific gene mutations can be linked to myelodysplastic syndromes (MDS) pathogenesis and therapy. Here, 44 higher-risk MDS patients were treated with azacitidine and lenalidomide and mutations analyses were performed at baseline and during the therapy. Results were then correlated to clinical outcome, overall survival (OS), leukemia-free-survival (LFS) and response to therapy. Collectively, 34/44 patients were considered evaluable for response, with an overall response rate of 76.25% (26/34 cases): 17 patients showed a durable response, 9 patients early lost response and 8 patients never responded. The most frequently mutated genes were ASXL1, TET2, RUNX1, and SRSF2. All patients early losing response, as well as cases never responding, acquired the same 3 point mutations during therapy, affecting respectively PIK3CD (D133E), AKT3 (D280G), and PLCG2 (Q548R) genes, that regulate cell proliferation and differentiation. Moreover, Kaplan-Meier analyses revealed that this mutated cluster was significantly associated with a shorter OS, LFS, and duration of response. All in all, a common mutated cluster affecting 3 inositide-specific genes is significantly associated with loss of response to azacitidine and lenalidomide therapy in higher risk MDS. Further studies are warranted to confirm these data and to further analyze the functional role of this 3-gene cluster.

journal_name

Leukemia

journal_title

Leukemia

authors

Follo MY,Pellagatti A,Armstrong RN,Ratti S,Mongiorgi S,De Fanti S,Bochicchio MT,Russo D,Gobbi M,Miglino M,Parisi S,Martinelli G,Cavo M,Luiselli D,McCubrey JA,Suh PG,Manzoli L,Boultwood J,Finelli C,Cocco L

doi

10.1038/s41375-019-0416-x

subject

Has Abstract

pub_date

2019-09-01 00:00:00

pages

2276-2290

issue

9

eissn

0887-6924

issn

1476-5551

pii

10.1038/s41375-019-0416-x

journal_volume

33

pub_type

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