Ras pathway mutations are prevalent in relapsed childhood acute lymphoblastic leukemia and confer sensitivity to MEK inhibition

Irving, J. et al. (2014) Ras pathway mutations are prevalent in relapsed childhood acute lymphoblastic leukemia and confer sensitivity to MEK inhibition. Blood, 124(23), pp. 3420-3430. (doi: 10.1182/blood-2014-04-531871) (PMID:25253770) (PMCID:PMC4246039)

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Publisher's URL: http://dx.doi.org/10.1182/blood-2014-04-531871


For most children who relapse with acute lymphoblastic leukaemia, the prognosis is poor and there is a need for novel therapies to improve outcome. We screened samples from children with B lineage ALL entered into the ALL-REZ BFM 2002 clinical trial (ClinicalTrials.gov identifier: NCT00114348) for somatic mutations activating the Ras pathway (KRAS, NRAS, FLT3 and PTPN11) and showed mutation to be highly prevalent (76 from 206). Clinically, they were associated with high risk features including early relapse, CNS involvement and specifically for NRAS/KRAS mutations, chemoresistance. KRAS mutations were associated with a reduced overall survival. Mutation screening of the matched diagnostic samples found many to be wildtype but using more sensitive allelic specific assays, low level mutated subpopulations were found in many cases, suggesting that they survived up front therapy and subsequently emerged at relapse. Preclinical evaluation of the MEK1/2 inhibitor, selumetinib (AZD6244, ARRY-142886) showed significant differential sensitivity in Ras pathway mutated ALL compared to wild type cells both in vitro and in a orthotopic xenograft model engrafted with primary ALL and in the latter, reduced RAS mutated CNS leukaemia. Given these data, clinical evaluation of selumetinib may be warranted for Ras pathway mutated relapsed ALL.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Halsey, Professor Chris
Authors: Irving, J., Matheson, E., Minto, L., Blair, H., Case, M., Halsey, C., Swidenbank, I., Ponthan, F., Kirschner-Schwabe, R., Groeneveld-Krentz, S., Hof, J., Allan, J., Harrison, C., Vormoor, J., von Stackelberg, A., and Eckert, C.
College/School:College of Medical Veterinary and Life Sciences > School of Infection & Immunity
Journal Name:Blood
Publisher:American Society of Hematology
ISSN (Online):1528-0020
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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
530441An investigation into the molecular basis for B lineage acute lymphoblastic leukaemia migration to extramedullary sites.Christina HalseyKay Kendal Leukaemia Fund (KAY-KENDAL)KKL454III -IMMUNOLOGY