Development and validation of a 10‐gene prognostic signature for acute myeloid leukaemia

Acute myeloid leukaemia (AML) is the most common type of adult acute leukaemia and has a poor prognosis. Thus, optimal risk stratification is of greatest importance for reasonable choice of treatment and prognostic evaluation. For our study, a total of 1707 samples of AML patients from three public databases were divided into meta‐training, meta‐testing and validation sets. The meta‐training set was used to build risk prediction model, and the other four data sets were employed for validation. By log‐rank test and univariate COX regression analysis as well as LASSO‐COX, AML patients were divided into high‐risk and low‐risk groups based on AML risk score (AMLRS) which was constituted by 10 survival‐related genes. In meta‐training, meta‐testing and validation sets, the patient in the low‐risk group all had a significantly longer OS (overall survival) than those in the high‐risk group (P < .001), and the area under ROC curve (AUC) by time‐dependent ROC was 0.5854‐0.7905 for 1 year, 0.6652‐0.8066 for 3 years and 0.6622‐0.8034 for 5 years. Multivariate COX regression analysis indicated that AMLRS was an independent prognostic factor in four data sets. Nomogram combining the AMLRS and two clinical parameters performed well in predicting 1‐year, 3‐year and 5‐year OS. Finally, we created a web‐based prognostic model to predict the prognosis of AML patients ( https://tcgi.shinyapps.io/amlrs_nomogram/ ).     

Effects of the multi-kinase inhibitor midostaurin in combination with chemotherapy in models of acute myeloid leukaemia

Recently, several targeted agents have been developed for specific subsets of patients with acute myeloid leukaemia (AML), including midostaurin, the first FDA-approved FLT3 inhibitor for newly diagnosed patients with FLT3 mutations. However, in the initial Phase I/II clinical trials, some patients without FLT3 mutations had transient responses to midostaurin, suggesting that this multi-targeted kinase inhibitor might benefit AML patients more broadly. Here, we demonstrate submicromolar efficacy of midostaurin in vitro and efficacy in vivo against wild-type (wt) FLT3-expressing AML cell lines and primary cells, and we compare its effectiveness with that of other FLT3 inhibitors currently in clinical trials. Midostaurin was found to synergize with standard chemotherapeutic drugs and some targeted agents against AML cells without mutations in FLT3. The mechanism may involve, in part, the unique kinase profile of midostaurin that includes proteins implicated in AML transformation, such as SYK or KIT, or inhibition of ERK pathway or proviability signalling. Our findings support further investigation of midostaurin as a chemosensitizing agent in AML patients without FLT3 mutations.