[HTML][HTML] JAK/STAT pathway inhibition overcomes IL7-induced glucocorticoid resistance in a subset of human T-cell acute lymphoblastic leukemias

C Delgado-Martin, LK Meyer, BJ Huang, KA Shimano… - Leukemia, 2017 - nature.com
C Delgado-Martin, LK Meyer, BJ Huang, KA Shimano, MS Zinter, JV Nguyen, GA Smith…
Leukemia, 2017nature.com
While outcomes for children with T-cell acute lymphoblastic leukemia (T-ALL) have
improved dramatically, survival rates for patients with relapsed/refractory disease remain
dismal. Prior studies indicate that glucocorticoid (GC) resistance is more common than
resistance to other chemotherapies at relapse. In addition, failure to clear peripheral blasts
during a prednisone prophase correlates with an elevated risk of relapse in newly
diagnosed patients. Here we show that intrinsic GC resistance is present at diagnosis in …
Abstract
While outcomes for children with T-cell acute lymphoblastic leukemia (T-ALL) have improved dramatically, survival rates for patients with relapsed/refractory disease remain dismal. Prior studies indicate that glucocorticoid (GC) resistance is more common than resistance to other chemotherapies at relapse. In addition, failure to clear peripheral blasts during a prednisone prophase correlates with an elevated risk of relapse in newly diagnosed patients. Here we show that intrinsic GC resistance is present at diagnosis in early thymic precursor (ETP) T-ALLs as well as in a subset of non-ETP T-ALLs. GC-resistant non-ETP T-ALLs are characterized by strong induction of JAK/STAT signaling in response to interleukin-7 (IL7) stimulation. Removing IL7 or inhibiting JAK/STAT signaling sensitizes these T-ALLs, and a subset of ETP T-ALLs, to GCs. The combination of the GC dexamethasone and the JAK1/2 inhibitor ruxolitinib altered the balance between pro-and anti-apoptotic factors in samples with IL7-dependent GC resistance, but not in samples with IL7-independent GC resistance. Together, these data suggest that the addition of ruxolitinib or other inhibitors of IL7 receptor/JAK/STAT signaling may enhance the efficacy of GCs in a biologically defined subset of T-ALL.
nature.com