The transcriptomic landscape of elderly acute myeloid leukemia identifies B7H3 and BANP as a favorable signature in high-risk patients.

Acute myeloid leukemia (AML) in the elderly remains a clinical challenge, with a five-year overall survival rate below 10%. The current ELN 2017 genetic risk classification considers cytogenetic and mutational characteristics to stratify fit AML patients into different prognostic groups. However, this classification is not validated for elderly patients treated with a non-intensive approach, and its performance may be suboptimal in this context. Indeed, the transcriptomic landscape of AML in the elderly has been less explored and it might help stratify this group of patients. In the current study, we analyzed the transcriptome of 224 AML patients > 65 years-old at diagnosis treated in the Spanish PETHEMA-FLUGAZA clinical trial in order to identify new prognostic biomarkers in this population. We identified a specific transcriptomic signature for high-risk patients with mutated TP53 or complex karyotype, revealing that low expression of B7H3 gene with high expression of BANP gene identifies a subset of high-risk AML patients surviving more than 12 months. This result was further validated in the BEAT AML cohort. This unique signature highlights the potential of transcriptomics to identify prognostic biomarkers in in elderly AML.
Competing Interests: RA: Membership on an entity´s Board of Directors advisory committees: Incyte Corporation, Astellas; Honoraria: Novartis, Celgene and Incyte. MT: declares honoraria for lectures from Celgene, Pfizer, Novartis, Janssen, Merck Sharp & Dohme (MSD), Daiichi, and Servier SL, and membership on advisory boards with Celgene, Novartis, Roche, and Astellas. JS: declares honoraria for lectures, and membership on advisory boards with, Daiichi Sankyo, Pfizer, Celgene, Novartis, Roche, and Amgen. BP: served as a consultant for and received honoraria from Adaptive, Amgen, Becton Dickinson, Bristol Myers Squibb/Celgene, GSK, Janssen, Roche, Sanofi, and Takeda; and received research support from Bristol Myers Squibb/Celgene, GSK, Roche, Sanofi, and Takeda JM-L: declares honoraria for lectures from, and membership on advisory boards with, Janssen, BMS, Sanofi, Novartis, Incyte, Roche, and Amgen; and membership on the boards of directors of Hosea and Altum Sequencing. JFS-M: reports Consultancy, membership on an entity´s Board of Directors advisory committees: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Karyopharm, Merck Sharpe & Dohme, Novartis, Regeneron, Roche, Sanofi, SecuraBio, Takeda. FP: Honoraria and research funding: Oryzon, Janssen, BMS-Celgene. PM: declares Consultancy, membership on an entity´s Board of Directors advisory committees, research funding, speaker’s bureau: Celgene, Sanofi, Incyte, Karyopharm, Novartis, Stemline/Menarini, Agios, Astellas Pharma, Daiichi Sankyo; Membership on an entity´s Board of Directors advisory committees: Pfizer, Teva, AbbVie; Research Funding, Speakers Bureau: Janssen; Consultancy: Tolero Pharmaceutical, Forma Therapeutics, Glycomimetics. The remaining authors declare no competing financial interests.
(Copyright © 2022 Villar, Ariceta, Agirre, Urribarri, Ayala, Martínez-Cuadrón, Bergua, Vives, Algarra, Tormo, Martínez, Serrano, Simoes, Herrera, Calasanz, Alfonso-Piérola, Paiva, Martínez-López, San Miguel, Prósper and Montesinos.)