Genetic Mutations and Cell Maturity Key Factors in Overcoming Treatment Resistance in Acute Myeloid Leukemia

A comprehensive international study led by researchers at the University of Colorado Cancer Center has shed light on why certain treatments for acute myeloid leukemia (AML) are not uniformly effective across all patients. The research highlights that genetic mutations combined with the developmental stage, or maturity, of leukemia cells significantly influence how patients respond to therapy, particularly a common drug combination of venetoclax and hypomethylating agents (HMA). Published in lood Cancer Discovery,

researchers analyzed data from a large cohort of 678 AML patients, making it the most extensive study of its kind regarding treatment response. The findings reveal that patients with a subtype of AML known as monocytic AML tend to have poorer outcomes, especially in the absence of the NPM1 gene mutation, which is typically associated with better prognosis. Additionally, these patients are more likely to carry other mutations such as KRAS, which are linked to resistance against the drugs.

"Patients with monocytic AML and no NPM1 mutation are nearly twice as likely to succumb to the disease," explained Dr. Daniel Pollyea, a lead researcher and professor of medicine at CU School of Medicine. "This indicates that not just genetic mutations but also the maturity level of the cancer cells at treatment onset plays a crucial role in treatment success."

Contrasting previous research focusing solely on genetic mutations or cell types, this study provides a more integrated understanding by examining both factors simultaneously. The researchers discovered that some AML cells can evade targeted therapies by exploiting cellular escape mechanisms, suggesting that future treatments should aim to target these resistance pathways.

The implications of this study are significant for clinical practice, as it offers a new framework to classify AML patients into different risk categories. Such classification could enable healthcare providers to better predict which patients are likely to respond to venetoclax-based therapies and personalize treatment plans accordingly.

Dr. Pollyea emphasized that this research marks a step toward truly personalized medicine in AML management. By evaluating a patient0s leukemia profile from day one, clinicians can select the most effective treatment strategy, potentially improving survival outcomes. The research team plans to expand the study with additional patient data and aims to initiate clinical trials that utilize this predictive model.

Contributing institutions include the Knight Cancer Institute at Oregon Health and Science University, various hospitals in France, and the Lineberger Comprehensive Cancer Center at the University of North Carolina. These collaborative efforts promise to advance AML treatment and deepen our understanding of resistance mechanisms, ultimately aiming to improve patient prognosis.

source: https://medicalxpress.com/news/2025-05-gene-mutations-cell-maturity-key.html