GAS6 expression identifies high-risk adult AML patients: potential implications for therapy

SP Whitman, J Kohlschmidt, K Maharry, S Volinia… - Leukemia, 2014 - nature.com
SP Whitman, J Kohlschmidt, K Maharry, S Volinia, K Mrózek, D Nicolet, S Schwind, H Becker
Leukemia, 2014nature.com
Emerging data demonstrate important roles for the TYRO3/AXL/MERTK receptor tyrosine
kinase (TAM RTK) family in diverse cancers. We investigated the prognostic relevance of
GAS6 expression, encoding the common TAM RTK ligand, in 270 adults (n= 71 aged< 60
years; n= 199 aged⩾ 60 years) with de novo cytogenetically normal acute myeloid leukemia
(CN-AML). Patients expressing GAS6 (GAS6+), especially those aged⩾ 60 years, more
often failed to achieve a complete remission (CR). In all patients, GAS6+ patients had …
Abstract
Emerging data demonstrate important roles for the TYRO3/AXL/MERTK receptor tyrosine kinase (TAM RTK) family in diverse cancers. We investigated the prognostic relevance of GAS6 expression, encoding the common TAM RTK ligand, in 270 adults (n= 71 aged< 60 years; n= 199 aged⩾ 60 years) with de novo cytogenetically normal acute myeloid leukemia (CN-AML). Patients expressing GAS6 (GAS6+), especially those aged⩾ 60 years, more often failed to achieve a complete remission (CR). In all patients, GAS6+ patients had shorter disease-free (DFS) and overall (OS) survival than patients without GAS6 expression (GAS6−). After adjusting for other prognostic markers, GAS6+ predicted CR failure (P= 0.02), shorter DFS (P= 0.004) and OS (P= 0.04). To gain further biological insights, we derived a GAS6-associated gene-expression signature (P< 0.001) that in GAS6+ patients included overexpressed BAALC and MN1, known to confer adverse prognosis in CN-AML, and overexpressed CXCL12, encoding stromal cell-derived factor, and its receptor genes, chemokine (CXC motif) receptor 4 (CXCR4) and CXCR7. This study reports for the first time that GAS6 expression is an adverse prognostic marker in CN-AML. Although GAS6 decoy receptors are not yet available in the clinic for GAS6+ CN-AML therapy, potential alternative therapies targeting GAS6+-associated pathways, for example, CXCR4 antagonists, may be considered for GAS6+ patients to sensitize them to chemotherapy.
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