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    [Efficacy of Haploidentical Hematopoietic Stem Cell Transplantation in Treatment of Intermediate Risk Acute Myeloid Leukemia with Negative for FLT3-ITD, NPM1 or Biallelic CEBPA Mutation]. Chen Chun,Qi Jia-Qian,Chu Tian-Tian,Wang Hong,Wu De-Pei,Ruan Chang-Geng,Han Yue Zhongguo shi yan xue ye xue za zhi OBJECTIVE:To compare the efficacy of haploidentical hematopoietic stem cell transplantation (hi-HSCT) HLA-matched sibling donor hematopoietic stem cell transplantation (MSD-HSCT) and post-remission chemotherapy (PR-CT) in treatment of intermediate risk acute myeloid leukemia with negative for FLT3-ITD, NPM1 or biallelic CEBPA mutation. METHODS:The clinical data of patients with intermediate risk NPM1/non-CEBPA/FLT3-ITD AML from October 2009 to May 2016 were retrospectively analyzed. RESULTS:The overall survival rate of the patients treated with PR-CT, MSD-HSCT or hi-HSCT was 63.7%, 71.7%, 75.5%, respectively (P<0.05); the disease-free survival (DFS) rate was 52.8%, 67.1%, 71.3% respectively (P<0.001); the cumulative incidence of relapse was 24.7%, 16.9%, 14.4% respectively (P<0.05); the non-relapse mortality was 26.2%, 17.3%, 14.4% reapectively (P>0.05). The analysis of transplantation, related adverse events showed that II-IV grade of aGVHD in the MSD-HSCT group and hi-HSCT group was 48.9% and 45.6% respectively (P>0.05); the extensive cGVHD event was 21.6% and 8.8% (P<0.05) respectively. CONCLUSION:The efficiency of hi-HSCT and MSD-HSCT is superior to that of PR-CT for treatment of patients with intermediate risk NPM1/non-CEBPA/FLT3-ITD AML after CR1, there is no statistically significant difference in the efficiency of consolidatorg treatment and the transplantation-related mortality between hi-HSCT and MSD-HSCT. 10.19746/j.cnki.issn.1009-2137.2020.03.003
    Dependence on Myb expression is attenuated in myeloid leukaemia with N-terminal CEBPA mutations. Volpe Giacomo,Cauchy Pierre,Walton David S,Ward Carl,Blakemore Daniel,Bayley Rachael,Clarke Mary L,Schmidt Luisa,Nerlov Claus,Garcia Paloma,Dumon Stéphanie,Grebien Florian,Frampton Jon Life science alliance Mutations at the N- or C-terminus of C/EBPα are frequent in acute myeloid leukaemia (AML) with normal karyotype. Here, we investigate the role of the transcription factor Myb in AMLs driven by different combinations of CEBPA mutations. Using knockdown of Myb in murine cell lines modelling the spectrum of CEBPA mutations, we show that the effect of reduced Myb depends on the mutational status of the two Cebpa alleles. Importantly, Myb knockdown fails to override the block in myeloid differentiation in cells with biallelic N-terminal C/EBPα mutations, demonstrating for the first time that the dependency on Myb is much lower in AML with this mutational profile. By comparing gene expression following Myb knockdown and chromatin immunoprecipitation sequencing data for the binding of C/EBPα isoforms, we provide evidence for a functional cooperation between C/EBPα and Myb in the maintenance of AML. This co-dependency breaks down when both alleles of CEBPA harbour N-terminal mutations, as a subset of C/EBPα-regulated genes only bind the short p30 C/EBPα isoform and, unlike other C/EBPα-regulated genes, do so without a requirement for Myb. 10.26508/lsa.201800207
    The prognostic impact of FLT3-ITD, NPM1 and CEBPa in cytogenetically intermediate-risk AML after first relapse. Kurosawa Saiko,Yamaguchi Hiroki,Yamaguchi Takuhiro,Fukunaga Keiko,Yui Shunsuke,Kanamori Heiwa,Usuki Kensuke,Uoshima Nobuhiko,Yanada Masamitsu,Takeuchi Jin,Mizuno Ishikazu,Kanda Junya,Okamura Hiroshi,Yano Shingo,Tashiro Haruko,Shindo Takero,Chiba Shigeru,Tomiyama Junji,Inokuchi Koiti,Fukuda Takahiro International journal of hematology We evaluated the impact of FLT3-ITD, NPM1 mutations, and double mutant CEBPa (dmCEBPa) on overall survival (OS) after relapse in patients with cytogenetically intermediate-risk acute myeloid leukemia (AML) who were treated with chemotherapy alone in the first remission (CR1). Patients aged 16-65 years diagnosed with cytogenetically intermediate-risk AML, and who achieved CR1 were included. We retrospectively analyzed FLT3-ITD, NPM1 mutations and CEBPa using samples obtained at diagnosis, which therefore did not affect the therapeutic decisions. Among 235 patients who had achieved CR1, 152 relapsed, and 52% of them achieved second CR. The rate of achieving second CR was significantly higher (85%) in those with dmCEBPa. Patients with FLT3-ITD had significantly worse OS after relapse than those without (19% vs 41%, p = 0.002), while OS was comparable between patients with and without NPM1 mutations (37% vs 34%, p = 0.309). Patients with dmCEBPa had improved OS than those without (61% vs 32%, p = 0.006). By multivariate analysis, FLT3-ITD was independently associated with worse OS after relapse [hazard ratio (HR) 1.99, 95% CI 1.27-3.12, p = 0.003], and dmCEBPa with improved OS (HR 0.40, 95% CI 0.17-0.93, p = 0.033). Our data show that screening for these mutations at diagnosis is useful for facilitating effective therapeutic decision-making even after relapse. 10.1007/s12185-020-02894-x
    CSF3R mutations were associated with an unfavorable prognosis in patients with acute myeloid leukemia with CEBPA double mutations. Su Long,Gao SuJun,Tan YeHui,Lin Hai,Liu XiaoLiang,Liu ShanShan,Yang Yan,Sun JingNan,Li Wei Annals of hematology The aim of this study was to explore the clinical features and prognostic significance of CSF3R mutations in AML patients with CEBPA double mutations (CEBPA). One hundred one AML patients with CEBPA were retrospectively analyzed in this study. Mutation status of CSF3R gene, clinical features, and long-term outcomes were analyzed. The frequency of CSF3R mutations in patients with CEBPA was 19.80% (20/101). Patients with CSF3R mutations were associated with a lower platelet (u = 2.728, P = 0.006) and higher leukocytes (u = 3.178, P = 0.001) compared with those with wide-type CSF3R gene. The 5-year relapse-free survival (RFS) was 18.7% in patients with CSF3R mutations, which was significantly lower than those with wide-type CSF3R (31.8%) (P = 0.015). The 5-year overall survival (OS) was also significantly different between patients with and without CSF3R mutations (17.5% versus 57.4%, P = 0.019). The prevalence of CSF3R mutations was high in AML patients with CEBPA, which indicated a poor prognosis, and CSF3R mutations may be a new potential candidate for prognostically re-stratifying AML patients with CEBPA. 10.1007/s00277-019-03699-7
    [CD7 expression and its prognostic significance in acute myeloid leukemia patients with wild-type or mutant CEBPA]. Zhu M Y,Zhu Y,Chen R R,Zhu L X,Zhu J J,Li X Y,Zhou D,Yang X D,Zheng Y L,Xie M X,Sun J N,Huang X B,Li L,Xie W Z,Ye X J Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi To analyze the prognostic value of CD7 expression in newly diagnosed acute myeloid leukemia (AML) patients, and to further explore the correlation between CD7 expression and CEBPA mutation, and to clarify the prognostic value of CD7(+) in AML patients with wild-type (WT) or mutant-type (MT) CEBPA. The clinical data of 298 newly diagnosed non-M(3) AML patients between January 2010 and December 2016 were analyzed retrospectively. The clinical characteristics and prognosis of CD7(+) and CD7(-) patients were respectively compared in all patients, and in patients with WT and MT CEBPA. The relationship between CD7 expression and CEBPA mutation was determined by chi-square, and the effects of CEBPA mutation on survival and prognosis in CD7(+) group by Kaplan-Meier method. In CD7(+) group, the frequencies of CEBPA mutation were 10.1% (single site) and 33.9% (double site) , significantly higher than those of the CD7(-) group (5.3% and 4.2%) (=0.000) . Subgroup prognostic analysis showed a lower CR rate (=0.001) and a higher RR (=0.023) in CD7(+) group comparing to those of CD7(-) group in AML patients with wild type CEBPA. There were no statistical difference between CD7(+) group and CD7(-) group in overall survival (OS) and disease free survival (>0.05) , while in the CEBPA mutant group the CD7(+) group has higher OS (=0.019) and DFS (=0.010) . Based on the CD7 expression and CEBPA mutation, 298 cases were divided into 3 subgroups, named as CD7(+)-CEBPA MT group, CD7(-) and CD7(+)-CEBPA WT group. The 3-year OS of the 3 groups were 80.2%, 48.0% and 30.6%, respectively (<0.001) , and the 3-year DFS were 74.1%, 37.4% and 22.2%, respectively (<0.001) . The CEBPA mutation rate was higher in CD7(+) AML patients then that of CD7(-) patients. CD7 expression has opposite prognostic significance in AML patients carrying the wild-type or mutant-type CEBPA. Based on CD7 expression and CEBPA mutation, a new risk stratification model can be established, which is helpful to guide the clinical individualized treatment for AML patients. 10.3760/cma.j.issn.0253-2727.2020.02.003
    CCAAT enhancer binding protein alpha (CEBPA) biallelic acute myeloid leukaemia: cooperating lesions, molecular mechanisms and clinical relevance. Wilhelmson Anna S,Porse Bo T British journal of haematology Recent advances in sequencing technologies have allowed for the identification of recurrent mutations in acute myeloid leukaemia (AML). The transcription factor CCAAT enhancer binding protein alpha (CEBPA) is frequently mutated in AML, and biallelic CEBPA-mutant AML was recognised as a separate disease entity in the recent World Health Organization classification. However, CEBPA mutations are co-occurring with other aberrations in AML, and together these lesions form the clonal hierarchy that comprises the leukaemia in the patient. Here, we aim to review the current understanding of co-occurring mutations in CEBPA-mutated AML and their implications for disease biology and clinical outcome. We will put emphasis on patterns of cooperation, how these lesions cooperate with CEBPA mutations and the underlying potential molecular mechanisms. Finally, we will relate this to patient outcome and future options for personalised medicine. 10.1111/bjh.16534
    The ASXL1-G643W variant accelerates the development of CEBPA mutant acute myeloid leukemia. D'Altri Teresa,Wilhelmson Anna S,Schuster Mikkel B,Wenzel Anne,Kalvisa Adrija,Pundhir Sachin,Hansen Anne Meldgaard,Porse Bo T Haematologica ASXL1 is one of the most commonly mutated genes in myeloid malignancies, including Myelodysplastic Syndrome (MDS) and Acute Myeloid Leukemia (AML). In order to further our understanding of the role of ASXL1 lesions in malignant hematopoiesis, we generated a novel knock-in mouse model carrying the most frequent ASXL1 mutation identified in MDS patients, p.G643WfsX12. Mutant mice did not display any major hematopoietic defects nor developed any apparent hematological disease. In AML patients, ASXL1 mutations co-occur with mutations in CEBPA and we therefore generated compound Cebpa and Asxl1 mutated mice. Using a transplantation model, we found that the mutated Asxl1 allele significantly accelerated disease development in a CEBPA mutant context. Importantly, we demonstrated that, similar to the human setting, Asxl1 mutated mice responded poorly to chemotherapy. This model therefore constitutes an excellent experimental system for further studies into the clinically important question of chemotherapy resistance mediated by mutant ASXL1. 10.3324/haematol.2019.235150
    CEBPA-regulated lncRNAs, new players in the study of acute myeloid leukemia. Hughes James M,Salvatori Beatrice,Giorgi Federico M,Bozzoni Irene,Fatica Alessandro Journal of hematology & oncology CCAAT/enhancer-binding protein-α (CEBPA) is a critical regulator of myeloid differentiation. Disruption of CEBPA function contributes to the development of acute myeloid leukemia (AML). CEBPA regulates a large number of protein coding genes of which several were shown to contribute to CEBPA function. In this study, we expand the analysis of CEBPA transcriptional targets to the newly identified class of long non-coding RNAs. We show that lncRNAs are a main component of the transcriptional program driven by C/EBPα and that many of these are also induced during granulocytic differentiation of AML cell lines supporting their relevance in proliferation arrest and differentiation. 10.1186/s13045-014-0069-1
    The multifaceted functions of C/EBPα in normal and malignant haematopoiesis. Ohlsson E,Schuster M B,Hasemann M,Porse B T Leukemia The process of blood formation, haematopoiesis, depends upon a small number of haematopoietic stem cells (HSCs) that reside in the bone marrow. Differentiation of HSCs is characterised by decreased expression of genes associated with self-renewal accompanied by a stepwise activation of genes promoting differentiation. Lineage branching is further directed by groups of cooperating and counteracting genes forming complex networks of lineage-specific transcription factors. Imbalances in such networks can result in blockage of differentiation, lineage reprogramming and malignant transformation. CCAAT/enhancer-binding protein-α (C/EBPα) was originally identified 30 years ago as a transcription factor that binds both promoter and enhancer regions. Most of the early work focused on the role of C/EBPα in regulating transcriptional processes as well as on its functions in key differentiation processes during liver, adipogenic and haematopoietic development. Specifically, C/EBPα was shown to control differentiation by its ability to coordinate transcriptional output with cell cycle progression. Later, its role as an important tumour suppressor, mainly in acute myeloid leukaemia (AML), was recognised and has been the focus of intense studies by a number of investigators. More recent work has revisited the role of C/EBPα in normal haematopoiesis, especially its function in HSCs, and also started to provide more mechanistic insights into its role in normal and malignant haematopoiesis. In particular, the differential actions of C/EBPα isoforms, as well as its importance in chromatin remodelling and cellular reprogramming, are beginning to be elucidated. Finally, recent work has also shed light on the dichotomous function of C/EBPα in AML by demonstrating its ability to act as both a tumour suppressor and promoter. In the present review, we will summarise the current knowledge on the functions of C/EBPα during normal and malignant haematopoiesis with special emphasis on the recent work. 10.1038/leu.2015.324
    Combined molecular and clinical prognostic index for relapse and survival in cytogenetically normal acute myeloid leukemia. Pastore Friederike,Dufour Annika,Benthaus Tobias,Metzeler Klaus H,Maharry Kati S,Schneider Stephanie,Ksienzyk Bianka,Mellert Gudrun,Zellmeier Evelyn,Kakadia Purvi M,Unterhalt Michael,Feuring-Buske Michaela,Buske Christian,Braess Jan,Sauerland Maria Cristina,Heinecke Achim,Krug Utz,Berdel Wolfgang E,Buechner Thomas,Woermann Bernhard,Hiddemann Wolfgang,Bohlander Stefan K,Marcucci Guido,Spiekermann Karsten,Bloomfield Clara D,Hoster Eva Journal of clinical oncology : official journal of the American Society of Clinical Oncology PURPOSE:Cytogenetically normal (CN) acute myeloid leukemia (AML) is the largest and most heterogeneous cytogenetic AML subgroup. For the practicing clinician, it is difficult to summarize the prognostic information of the growing number of clinical and molecular markers. Our purpose was to develop a widely applicable prognostic model by combining well-established pretreatment patient and disease characteristics. PATIENTS AND METHODS:Two prognostic indices for CN-AML (PINA), one regarding overall survival (OS; PINAOS) and the other regarding relapse-free survival (RFS; PINARFS), were derived from data of 572 patients with CN-AML treated within the AML Cooperative Group 99 study (www.aml-score.org). RESULTS:On the basis of age (median, 60 years; range, 17 to 85 years), performance status, WBC count, and mutation status of NPM1, CEBPA, and FLT3-internal tandem duplication, patients were classified into the following three risk groups according to PINAOS and PINARFS: 29% of all patients and 32% of 381 responding patients had low-risk disease (5-year OS, 74%; 5-year RFS, 55%); 56% of all patients and 39% of responding patients had intermediate-risk disease (5-year OS, 28%; 5-year RFS, 27%), and 15% of all patients and 29% of responding patients had high-risk disease (5-year OS, 3%; 5-year RFS, 5%), respectively. PINAOS and PINARFS stratified outcome within European LeukemiaNet genetic groups. Both indices were confirmed on independent data from Cancer and Leukemia Group B/Alliance trials. CONCLUSION:We have developed and validated, to our knowledge, the first prognostic indices specifically designed for adult patients of all ages with CN-AML that combine well-established molecular and clinical variables and that are easily applicable in routine clinical care. The integration of both clinical and molecular markers could provide a basis for individualized patient care through risk-adapted therapy of CN-AML. 10.1200/JCO.2013.52.3480
    Translational implications of somatic genomics in acute myeloid leukaemia. Meyer Sara C,Levine Ross L The Lancet. Oncology SUMMARY:Acute myeloid leukaemia (AML) is caused by acquired somatic mutations in haemopoietic progenitors. Understanding of the genetic basis of the disease has greatly benefited from the use of DNA sequencing to identify novel disease alleles. Chromosomal aberrations are known to drive AML and are the mainstay of risk classification. Mutations in FLT3, NPM1, and CEBPA provide prognostic information and have been integrated into clinical diagnostics and clinical practice. Comprehensive next-generation sequencing studies have given insight into AML pathogenesis. These insights are leading to refined prognostic stratification and suggest differentially tailored treatment based on integrated genetic profiles. Translation of comprehensive genetic analyses to the clinical setting is the next challenge, to enable genotype-specific therapies for patients with AML and other malignant disorders. 10.1016/S1470-2045(14)70008-7
    Spectrum and prognostic relevance of driver gene mutations in acute myeloid leukemia. Metzeler Klaus H,Herold Tobias,Rothenberg-Thurley Maja,Amler Susanne,Sauerland Maria C,Görlich Dennis,Schneider Stephanie,Konstandin Nikola P,Dufour Annika,Bräundl Kathrin,Ksienzyk Bianka,Zellmeier Evelyn,Hartmann Luise,Greif Philipp A,Fiegl Michael,Subklewe Marion,Bohlander Stefan K,Krug Utz,Faldum Andreas,Berdel Wolfgang E,Wörmann Bernhard,Büchner Thomas,Hiddemann Wolfgang,Braess Jan,Spiekermann Karsten, Blood The clinical and prognostic relevance of many recently identified driver gene mutations in adult acute myeloid leukemia (AML) is poorly defined. We sequenced the coding regions or hotspot areas of 68 recurrently mutated genes in a cohort of 664 patients aged 18 to 86 years treated on 2 phase 3 trials of the German AML Cooperative Group (AMLCG). The median number of 4 mutations per patient varied according to cytogenetic subgroup, age, and history of previous hematologic disorder or antineoplastic therapy. We found patterns of significantly comutated driver genes suggesting functional synergism. Conversely, we identified 8 virtually nonoverlapping patient subgroups, jointly comprising 78% of AML patients, that are defined by mutually exclusive genetic alterations. These subgroups, likely representing distinct underlying pathways of leukemogenesis, show widely divergent outcomes. Furthermore, we provide detailed information on associations between gene mutations, clinical patient characteristics, and therapeutic outcomes in this large cohort of uniformly treated AML patients. In multivariate analyses including a comprehensive set of molecular and clinical variables, we identified DNMT3A and RUNX1 mutations as important predictors of shorter overall survival (OS) in AML patients <60 years, and particularly in those with intermediate-risk cytogenetics. NPM1 mutations in the absence of FLT3-ITD, mutated TP53, and biallelic CEBPA mutations were identified as important molecular prognosticators of OS irrespective of patient age. In summary, our study provides a comprehensive overview of the spectrum, clinical associations, and prognostic relevance of recurrent driver gene mutations in a large cohort representing a broad spectrum and age range of intensively treated AML patients. 10.1182/blood-2016-01-693879
    Disease evolution and outcomes in familial AML with germline CEBPA mutations. Tawana Kiran,Wang Jun,Renneville Aline,Bödör Csaba,Hills Robert,Loveday Chey,Savic Aleksandar,Van Delft Frederik W,Treleaven Jennifer,Georgiades Panayiotis,Uglow Elizabeth,Asou Norio,Uike Naokuni,Debeljak Maruša,Jazbec Janez,Ancliff Philip,Gale Rosemary,Thomas Xavier,Mialou Valerie,Döhner Konstanze,Bullinger Lars,Mueller Beatrice,Pabst Thomas,Stelljes Matthias,Schlegelberger Brigitte,Wozniak Eva,Iqbal Sameena,Okosun Jessica,Araf Shamzah,Frank Anne-Katrine,Lauridsen Felicia B,Porse Bo,Nerlov Claus,Owen Carolyn,Dokal Inderjeet,Gribben John,Smith Matthew,Preudhomme Claude,Chelala Claude,Cavenagh Jamie,Fitzgibbon Jude Blood In-depth molecular investigation of familial leukemia has been limited by the rarity of recognized cases. This study examines the genetic events initiating leukemia and details the clinical progression of disease across multiple families harboring germ-line CEBPA mutations. Clinical data were collected from 10 CEBPA-mutated families, representing 24 members with acute myeloid leukemia (AML). Whole-exome (WES) and deep sequencing were performed to genetically profile tumors and define patterns of clonal evolution. Germline CEBPA mutations clustered within the N-terminal and were highly penetrant, with AML presenting at a median age of 24.5 years (range, 1.75-46 years). In all diagnostic tumors tested (n = 18), double CEBPA mutations (CEBPAdm) were detected, with acquired (somatic) mutations preferentially targeting the C-terminal. Somatic CEBPA mutations were unstable throughout the disease course, with different mutations identified at recurrence. Deep sequencing of diagnostic and relapse paired samples confirmed that relapse-associated CEBPA mutations were absent at diagnosis, suggesting recurrence was triggered by novel, independent clones. Integrated WES and deep sequencing subsequently revealed an entirely new complement of mutations at relapse, verifying the presentation of a de novo leukemic episode. The cumulative incidence of relapse in familial AML was 56% at 10 years (n = 11), and 3 patients experienced ≥3 disease episodes over a period of 17 to 20 years. Durable responses to secondary therapies were observed, with prolonged median survival after relapse (8 years) and long-term overall survival (10-year overall survival, 67%). Our data reveal that familial CEBPA-mutated AML exhibits a unique model of disease progression, associated with favorable long-term outcomes. 10.1182/blood-2015-05-647172
    Mutant CEBPA directly drives the expression of the targetable tumor-promoting factor CD73 in AML. Jakobsen Janus S,Laursen Linea G,Schuster Mikkel B,Pundhir Sachin,Schoof Erwin,Ge Ying,d'Altri Teresa,Vitting-Seerup Kristoffer,Rapin Nicolas,Gentil Coline,Jendholm Johan,Theilgaard-Mönch Kim,Reckzeh Kristian,Bullinger Lars,Döhner Konstanze,Hokland Peter,Fitzgibbon Jude,Porse Bo T Science advances The key myeloid transcription factor (TF), CEBPA, is frequently mutated in acute myeloid leukemia (AML), but the direct molecular effects of this leukemic driver mutation remain elusive. To investigate mutant AML, we performed microscale, in vivo chromatin immunoprecipitation sequencing and identified a set of aberrantly activated enhancers, exclusively occupied by the leukemia-associated CEBPA-p30 isoform. Comparing gene expression changes in human mutant AML and the corresponding mouse model, we identified , encoding CD73, as a cross-species AML gene with an upstream leukemic enhancer physically and functionally linked to the gene. Increased expression of CD73, mediated by the CEBPA-p30 isoform, sustained leukemic growth via the CD73/A2AR axis. Notably, targeting of this pathway enhanced survival of AML-transplanted mice. Our data thus indicate a first-in-class link between a cancer driver mutation in a TF and a druggable, direct transcriptional target. 10.1126/sciadv.aaw4304
    Pharmacological targeting of the Wdr5-MLL interaction in C/EBPα N-terminal leukemia. Grebien Florian,Vedadi Masoud,Getlik Matthäus,Giambruno Roberto,Grover Amit,Avellino Roberto,Skucha Anna,Vittori Sarah,Kuznetsova Ekaterina,Smil David,Barsyte-Lovejoy Dalia,Li Fengling,Poda Gennadiy,Schapira Matthieu,Wu Hong,Dong Aiping,Senisterra Guillermo,Stukalov Alexey,Huber Kilian V M,Schönegger Andreas,Marcellus Richard,Bilban Martin,Bock Christoph,Brown Peter J,Zuber Johannes,Bennett Keiryn L,Al-Awar Rima,Delwel Ruud,Nerlov Claus,Arrowsmith Cheryl H,Superti-Furga Giulio Nature chemical biology The CEBPA gene is mutated in 9% of patients with acute myeloid leukemia (AML). Selective expression of a short (30-kDa) CCAAT-enhancer binding protein-α (C/EBPα) translational isoform, termed p30, represents the most common type of CEBPA mutation in AML. The molecular mechanisms underlying p30-mediated transformation remain incompletely understood. We show that C/EBPα p30, but not the normal p42 isoform, preferentially interacts with Wdr5, a key component of SET/MLL (SET-domain/mixed-lineage leukemia) histone-methyltransferase complexes. Accordingly, p30-bound genomic regions were enriched for MLL-dependent H3K4me3 marks. The p30-dependent increase in self-renewal and inhibition of myeloid differentiation required Wdr5, as downregulation of the latter inhibited proliferation and restored differentiation in p30-dependent AML models. OICR-9429 is a new small-molecule antagonist of the Wdr5-MLL interaction. This compound selectively inhibited proliferation and induced differentiation in p30-expressing human AML cells. Our data reveal the mechanism of p30-dependent transformation and establish the essential p30 cofactor Wdr5 as a therapeutic target in CEBPA-mutant AML. 10.1038/nchembio.1859
    Whole exome sequencing reveals a C-terminal germline variant in CEBPA-associated acute myeloid leukemia: 45-year follow up of a large family. Pathak Anand,Seipel Katja,Pemov Alexander,Dewan Ramita,Brown Christina,Ravichandran Sarangan,Luke Brian T,Malasky Michael,Suman Shalabh,Yeager Meredith, , ,Gatti Richard A,Caporaso Neil E,Mulvihill John J,Goldin Lynn R,Pabst Thomas,McMaster Mary L,Stewart Douglas R Haematologica Familial acute myeloid leukemia is rare and linked to germline mutations in RUNX1, GATA2 or CCAAT/enhancer binding protein-α (CEBPA). We re-evaluated a large family with acute myeloid leukemia originally seen at NIH in 1969. We used whole exome sequencing to study this family, and conducted in silico bioinformatics analysis, protein structural modeling and laboratory experiments to assess the impact of the identified CEBPA Q311P mutation. Unlike most previously identified germline mutations in CEBPA, which were N-terminal frameshift mutations, we identified a novel Q311P variant that was located in the C-terminal bZip domain of C/EBPα. Protein structural modeling suggested that the Q311P mutation alters the ability of the CEBPA dimer to bind DNA. Electrophoretic mobility shift assays showed that the Q311P mu-tant had attenuated binding to DNA, as predicted by the protein modeling. Consistent with these findings, we found that the Q311P mutation has reduced transactivation, consistent with a loss-of-function mutation. From 45 years of follow up, we observed incomplete penetrance (46%) of CEBPA Q311P. This study of a large multi-generational pedigree reveals that a germline mutation in the C-terminal bZip domain can alter the ability of C/EBP-α to bind DNA and reduces transactivation, leading to acute myeloid leukemia. 10.3324/haematol.2015.130799
    Decision Analysis of Postremission Therapy in Cytogenetically Intermediate-Risk Acute Myeloid Leukemia: The Impact of FLT3 Internal Tandem Duplication, Nucleophosmin, and CCAAT/Enhancer Binding Protein Alpha. Kurosawa Saiko,Yamaguchi Hiroki,Yamaguchi Takuhiro,Fukunaga Keiko,Yui Shunsuke,Wakita Satoshi,Kanamori Heiwa,Usuki Kensuke,Uoshima Nobuhiko,Yanada Masamitsu,Shono Katsuhiro,Ueki Toshimitsu,Mizuno Ishikazu,Yano Shingo,Takeuchi Jin,Kanda Junya,Okamura Hiroshi,Inamoto Yoshihiro,Inokuchi Koiti,Fukuda Takahiro Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation We performed a decision analysis comparing allogeneic hematopoietic cell transplantation (allo-HCT) versus chemotherapy in first complete remission for patients with cytogenetically intermediate-risk acute myeloid leukemia, depending on the presence or absence of FLT3-internal tandem duplication (ITD), nucleophosmin (NPM1), and CCAAT/enhancer binding protein alpha (CEBPA) mutations. Adjusted means of the patient-reported EQ-5D index were used as quality-of-life (QOL) estimates. In 332 patients for which FLT3-ITD status was available, FLT3-ITD was present in 60. In 272 patients without FLT3-ITD, NPM1 mutations were present in 83. CEBPA biallelic mutations were detected in 53 patients. For patients harboring FLT3-ITD, allo-HCT improved life expectancy (LE) (52 versus 32 months during 10-year observation) and QOL-adjusted life expectancy (QALE, 36 versus 21). Monte-Carlo simulation identified allo-HCT as the favored strategy in 100% of simulations. In patients without FLT3-ITD, allo-HCT improved LE/QALE with or without NPM1 mutations. However, sensitivity analyses showed that the results were not robust enough. For patients harboring CEBPA biallelic mutations, chemotherapy was favored (LE, 53 versus 84; QALE, 37 versus 59), whereas, for patients with monoallelic mutations or wild-type CEBPA, allo-HCT was favored (LE, 68 versus 54; QALE, 48 versus 37). Sensitivity analyses did not change the results in either group. In conclusion, based on a Markov decision analysis, allo-HCT was a favored postremission strategy in patients with FLT3-ITD, and chemotherapy was favored in patients with biallelic CEBPA mutations. A prospective study is warranted to determine the value of allo-HCT, especially in FLT3-ITD-negative patients. 10.1016/j.bbmt.2016.03.015
    [Roles of CCAAT enhancer binding protein α in acute myeloblastic leukemia]. Shi Ting,Ye Xiujin Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences The CCAAT enhancer binding protein α (C/EBP α:p42 and p30),which encoded by CCAAT enhancer binding protein α () gene,plays a pretty crucial role in the regulation of myeloid hematopoiesis.The disorder of CEBPA gene expression is an pivotal mechanism of acute myeloid leukemia (AML). The result of uncontrolled expression of C/EBP α gene is the over-expression of p30 and the incomplete loss of p42, both of which contribute to the occurrence of AML. Restoring the expression ratio of C/EBP α such as over-expression of p42 or blocking the carcinogenic pathway of p30 seems to be important for the treatment of AML caused by such causes. In order to better guide medical decision-making, this article reviews research progress on C/EBPα in the pathogenesis of AML.
    Functional interaction of CCAAT/enhancer-binding-protein-α basic region mutants with E2F transcription factors and DNA. Kowenz-Leutz Elisabeth,Schuetz Anja,Liu Qingbin,Knoblich Maria,Heinemann Udo,Leutz Achim Biochimica et biophysica acta The transcription factor CCAAT/enhancer-binding protein α (C/EBPα) regulates cell cycle arrest and terminal differentiation of neutrophils and adipocytes. Mutations in the basic leucine zipper domain (bZip) of C/EBPα are associated with acute myeloid leukemia. A widely used murine transforming C/EBPα basic region mutant (BRM2) entails two bZip point mutations (I294A/R297A). BRM2 has been discordantly described as defective for DNA binding or defective for interaction with E2F. We have separated the two BRM2 mutations to shed light on the intertwined reciprocity between C/EBPα-E2F-DNA interactions. Both, C/EBPα I294A and R297A retain transactivation capacity and interaction with E2F-DP. The C/EBPα R297A mutation destabilized DNA binding, whereas the C/EBPα I294A mutation enhanced binding to DNA. The C/EBPα R297A mutant, like BRM2, displayed enhanced interaction with E2F-DP but failed to repress E2F-dependent transactivation although both mutants were readily suppressed by E2F1 for transcription through C/EBP cis-regulatory sites. In contrast, the DNA binding enhanced C/EBPα I294A mutant displayed increased repression of E2F-DP mediated transactivation and resisted E2F-DP mediated repression. Thus, the efficient repression of E2F dependent S-phase genes and the activation of differentiation genes reside in the balanced DNA binding capacity of C/EBPα. 10.1016/j.bbagrm.2016.04.008
    Prognostic utility of six mutated genes for older patients with acute myeloid leukemia. Wang Jinghan,Ma Zhixin,Wang Qinrong,Guo Qi,Huang Jiansong,Yu Wenjuan,Wang Huanping,Huang Jingwen,Washington Shao Yang,Chen Suning,Jin Jie International journal of cancer Approximately 50% of older patients with acute myeloid leukemia (AML) do not obtain chromosomal abnormalities as an effective risk-stratification, and present cytogenetically normal AML (CN-AML). To develop a reliable prediction model for stratifying the risk of these elderly patients, we conducted a study with a discovery and validation design. As a result, we found the top 6 mutated genes in the discovery cohort of 26 case by the whole exome sequencing, and verified as recurrent mutations in the large cohort of 329 patients by Sanger sequencing. The top 6 genes were NPM1, FLT3-ITD, DNMT3A, CEBPA double allele, IDH1 and IDH2 mutations, and the frequency of each gene in the combining cohort was 36.8%, 19.8%, 20.1%, 5.8%, 14.9% and 22.5%, respectively. In addition, clinical variables such as age, white blood cell counts, genes of IDH1 and DNMT3A mutations, European LeukemiaNet genotype (NPM1 mutations and lacking FLT3-ITD or CEBPA double allele mutations) and treatment protocols were independent factors for predicting the probabilities of overall and event-free survival. The prediction nomograms based on these significant factors showed accurate discrimination. In conclusion, we developed a reliable prediction model for stratifying the risk of elderly patients with CN-AML. 10.1002/ijc.31178
    Companion gene mutations and their clinical significance in AML with double mutant CEBPA. Zhang Yang,Wang Fang,Chen Xue,Zhang Yu,Wang Mingyu,Liu Hong,Teng Wen,Cao Panxiang,Nie Daijing,Ma Xiaoli,Wang Tong,Lu Peihua,Liu Hongxing Cancer gene therapy Acute myeloid leukemia (AML) with double mutant CEBPA (CEBPAdm) is generally associated with favorable prognosis, but the heterogeneity still blatant and needs further exploration. We aimed to comprehensively analyze the companion genetic abnormalities and their clinical significance in AML patients with CEBPAdm. By performed targeted amplicon sequencing of 58 genes in specimens at the time of initial diagnosis of 609 AML patients, we identified 76 cases (12.5%) were CEBPAdm, and 88.2% of them also carry other gene mutations. There were more additional gene mutations, especially more epigenetic modifiers gene mutations in CEBPAsm than CEBPAdm cases, while GATA2, CSF3R, JAK3, and KIT mutations were exclusively betide in CEBPAdm but not CEBPAsm. Mutations of tyrosine kinase genes confer to adverse prognostic in karyotype normal CEBPAdm AML and provide potential therapeutic targets. The incidence of germline CEBPA mutation in CEBPAdm cases was 5.3% (4/76), including one C-terminal mutation. Deciphering the mutation spectrum of CEBPAdm AML could facilitate an in-depth understanding of the pathogenesis and refine the prognostic classification of this disease entity. 10.1038/s41417-019-0133-7
    JAKed up phenotype of CEBPA-mutant AML. Tyner Jeffrey W Blood 10.1182/blood-2016-04-709535
    Maxson JE, Ries RE, Wang Y-C, et al. CSF3R mutations have a high degree of overlap with CEBPA mutations in pediatric AML. Blood. 2016;127(24):3094-3098. Blood 10.1182/blood-2016-11-751834
    Identification of a novel enhancer of CEBPE essential for granulocytic differentiation. Shyamsunder Pavithra,Shanmugasundaram Mahalakshmi,Mayakonda Anand,Dakle Pushkar,Teoh Weoi Woon,Han Lin,Kanojia Deepika,Lim Mei Chee,Fullwood Melissa,An Omer,Yang Henry,Shi Jizhong,Hossain Mohammad Zakir,Madan Vikas,Koeffler H Phillip Blood CCAAT/enhancer binding protein ε (CEBPE) is an essential transcription factor for granulocytic differentiation. Mutations of occur in individuals with neutrophil-specific granule deficiency (SGD), which is characterized by defects in neutrophil maturation. -knockout mice also exhibit defects in terminal differentiation of granulocytes, a phenotype reminiscent of SGD. Analysis of DNase I hypersensitive sites sequencing data revealed an open chromatin region 6 kb downstream of the transcriptional start site of in murine myeloid cells. We identified an interaction between this +6-kb region and the core promoter of using circular chromosome conformation capture sequencing (4C-seq). To understand the role of this putative enhancer in transcriptional regulation of , we targeted it using catalytically inactive Cas9 fused to Krüppel-associated box (KRAB) domain and observed a significant downregulation of transcript and protein levels of CEBPE in cells expressing guide RNA targeting the +6-kb region. To further investigate the role of this novel enhancer further in myelopoiesis, we generated mice with deletion of this region using CRISPR/Cas9 technology. Germline deletion of the +6-kb enhancer resulted in reduced levels of CEBPE and its target genes and caused a severe block in granulocytic differentiation. We also identified binding of CEBPA and CEBPE to the +6-kb enhancer, which suggests their role in regulating the expression of In summary, we have identified a novel enhancer crucial for regulating expression of and required for normal granulocytic differentiation. 10.1182/blood.2018886077
    Secondary leukemia in patients with germline transcription factor mutations (RUNX1, GATA2, CEBPA). Brown Anna L,Hahn Christopher N,Scott Hamish S Blood Recognition that germline mutations can predispose individuals to blood cancers, often presenting as secondary leukemias, has largely been driven in the last 20 years by studies of families with inherited mutations in the myeloid transcription factors (TFs) RUNX1, GATA2, and CEBPA. As a result, in 2016, classification of myeloid neoplasms with germline predisposition for each of these and other genes was added to the World Health Organization guidelines. The incidence of germline mutation carriers in the general population or in various clinically presenting patient groups remains poorly defined for reasons including that somatic mutations in these genes are common in blood cancers, and our ability to distinguish germline (inherited or de novo) and somatic mutations is often limited by the laboratory analyses. Knowledge of the regulation of these TFs and their mutant alleles, their interaction with other genes and proteins and the environment, and how these alter the clinical presentation of patients and their leukemias is also incomplete. Outstanding questions that remain for patients with these germline mutations or their treating clinicians include: What is the natural course of the disease? What other symptoms may I develop and when? Can you predict them? Can I prevent them? and What is the best treatment? The resolution of many of the remaining clinical and biological questions and effective evidence-based treatment of patients with these inherited mutations will depend on worldwide partnerships among patients, clinicians, diagnosticians, and researchers to aggregate sufficient longitudinal clinical and laboratory data and integrate these data with model systems. 10.1182/blood.2019000937
    NPM1-mutated acute myeloid leukemia: from bench to bedside. Falini Brunangelo,Brunetti Lorenzo,Sportoletti Paolo,Martelli Maria Paola Blood The nucleophosmin (NPM1) gene encodes for a multifunctional protein with prominent nucleolar localization that shuttles between nucleus and cytoplasm. NPM1 mutations represent the most common genetic lesion in adult acute myeloid leukemia (AML; about one third of cases), and they act deterministically to cause the aberrant cytoplasmic delocalization of NPM1 mutants. Because of its unique features, NPM1-mutated AML is recognized as a distinct entity in the 2017 World Health Organization (WHO) classification of hematopoietic neoplasms. Here, we focus on recently identified functions of wild-type NPM1 in the nucleolus and address new biological and clinical issues related to NPM1-mutated AML. The relevance of the cooperation between NPM1 and other mutations in driving AML with different outcomes is presented. We also discuss the importance of eradicating NPM1-mutated clones to achieve AML cure and the impact of preleukemic clonal hematopoiesis persistence in predisposing to second AML. The contribution of HOX genes' expression to the development of NPM1-mutated AML is also highlighted. Clinically, yet unsolved diagnostic issues in the 2017 WHO classification of myeloid neoplasms and the importance of NPM1 mutations in defining the framework of European LeukemiaNet genetic-based risk stratification are discussed. Finally, we address the value and limits of NPM1-based measurable residual disease assessment for treatment guidance and present the results of promising preclinical studies with XPO1 and menin-MLL inhibitors. 10.1182/blood.2019004226
    Myeloid lineage enhancers drive oncogene synergy in CEBPA/CSF3R mutant acute myeloid leukemia. Braun Theodore P,Okhovat Mariam,Coblentz Cody,Carratt Sarah A,Foley Amy,Schonrock Zachary,Smith Brittany M,Nevonen Kimberly,Davis Brett,Garcia Brianna,LaTocha Dorian,Weeder Benjamin R,Grzadkowski Michal R,Estabrook Joey C,Manning Hannah G,Watanabe-Smith Kevin,Jeng Sophia,Smith Jenny L,Leonti Amanda R,Ries Rhonda E,McWeeney Shannon,Di Genua Cristina,Drissen Roy,Nerlov Claus,Meshinchi Soheil,Carbone Lucia,Druker Brian J,Maxson Julia E Nature communications Acute Myeloid Leukemia (AML) develops due to the acquisition of mutations from multiple functional classes. Here, we demonstrate that activating mutations in the granulocyte colony stimulating factor receptor (CSF3R), cooperate with loss of function mutations in the transcription factor CEBPA to promote acute leukemia development. The interaction between these distinct classes of mutations occurs at the level of myeloid lineage enhancers where mutant CEBPA prevents activation of a subset of differentiation associated enhancers. To confirm this enhancer-dependent mechanism, we demonstrate that CEBPA mutations must occur as the initial event in AML initiation. This improved mechanistic understanding will facilitate therapeutic development targeting the intersection of oncogene cooperativity. 10.1038/s41467-019-13364-2
    -double-mutated acute myeloid leukemia displays a unique phenotypic profile: a reliable screening method and insight into biological features. Mannelli Francesco,Ponziani Vanessa,Bencini Sara,Bonetti Maria Ida,Benelli Matteo,Cutini Ilaria,Gianfaldoni Giacomo,Scappini Barbara,Pancani Fabiana,Piccini Matteo,Rondelli Tommaso,Caporale Roberto,Gelli Anna Maria Grazia,Peruzzi Benedetta,Chiarini Marco,Borlenghi Erika,Spinelli Orietta,Giupponi Damiano,Zanghì Pamela,Bassan Renato,Rambaldi Alessandro,Rossi Giuseppe,Bosi Alberto Haematologica Mutations in CCAAT/enhancer binding protein α () occur in 5-10% of cases of acute myeloid leukemia. -double-mutated cases usually bear biallelic N- and C-terminal mutations and are associated with a favorable clinical outcome. Identification of mutants is challenging because of the variety of mutations, intrinsic characteristics of the gene and technical issues. Several screening methods (fragment-length analysis, gene expression array) have been proposed especially for large-scale clinical use; although efficient, they are limited by specific concerns. We investigated the phenotypic profile of blast and maturing bone marrow cell compartments at diagnosis in 251 cases of acute myeloid leukemia. In this cohort, 16 (6.4%) patients had two mutations, whereas ten (4.0%) had a single mutation. First, we highlighted that the -double-mutated subset displays recurrent phenotypic abnormalities in all cell compartments. By mutational analysis after cell sorting, we demonstrated that this common phenotypic signature depends on -double-mutated multi-lineage involvement. From a multidimensional study of phenotypic data, we developed a classifier including ten core and widely available parameters. The selected markers on blasts (CD34, CD117, CD7, CD15, CD65), neutrophil (SSC, CD64), monocytic (CD14, CD64) and erythroid (CD117) compartments were able to cluster -double-mutated cases. In a validation set of 259 AML cases from three independent centers, our classifier showed excellent performance with 100% specificity and 100% sensitivity. We have, therefore, established a reliable screening method, based upon multidimensional analysis of widely available phenotypic parameters. This method provides early results and is suitable for large-scale detection of -double-mutated status, allowing gene sequencing to be focused in selected cases. 10.3324/haematol.2016.151910
    Gain-of-Function Effects of N-Terminal CEBPA Mutations in Acute Myeloid Leukemia. Schmidt Luisa,Heyes Elizabeth,Grebien Florian BioEssays : news and reviews in molecular, cellular and developmental biology Mutations in the CEBPA gene are present in 10-15% of acute myeloid leukemia (AML) patients. The most frequent type of mutations leads to the expression of an N-terminally truncated variant of the transcription factor CCAAT/enhancer-binding protein alpha (C/EBPα), termed p30. While initial reports proposed that p30 represents a dominant-negative version of the wild-type C/EBPα protein, other studies show that p30 retains the capacity to actively regulate gene expression. Recent global transcriptomic and epigenomic analyses have advanced the understanding of the distinct roles of the p30 isoform in leukemogenesis. This review outlines direct and indirect effects of the C/EBPα p30 variant on oncogenic transformation of hematopoietic progenitor cells and discusses how studies of N-terminal CEBPA mutations in AML can be extrapolated to identify novel gain-of-function features in oncoproteins that arise from recurrent truncating mutations in transcription factors. 10.1002/bies.201900178