GAS6 expression identifies high-risk adult AML patients: potential implications for therapy

Leukemia. 2014 Jun;28(6):1252-1258. doi: 10.1038/leu.2013.371. Epub 2013 Dec 11.

Abstract

Emerging data demonstrate important roles for the TYRO3/AXL/MERTK receptor tyrosine kinase (TAM RTK) family in diverse cancers. We investigated the prognostic relevance of GAS6 expression, encoding the common TAM RTK ligand, in 270 adults (n=71 aged<60 years; n=199 aged ⩾60 years) with de novo cytogenetically normal acute myeloid leukemia (CN-AML). Patients expressing GAS6 (GAS6+), especially those aged ⩾60 years, more often failed to achieve a complete remission (CR). In all patients, GAS6+ patients had shorter disease-free (DFS) and overall (OS) survival than patients without GAS6 expression (GAS6-). After adjusting for other prognostic markers, GAS6+ predicted CR failure (P=0.02), shorter DFS (P=0.004) and OS (P=0.04). To gain further biological insights, we derived a GAS6-associated gene-expression signature (P<0.001) that in GAS6+ patients included overexpressed BAALC and MN1, known to confer adverse prognosis in CN-AML, and overexpressed CXCL12, encoding stromal cell-derived factor, and its receptor genes, chemokine (C-X-C motif) receptor 4 (CXCR4) and CXCR7. This study reports for the first time that GAS6 expression is an adverse prognostic marker in CN-AML. Although GAS6 decoy receptors are not yet available in the clinic for GAS6+ CN-AML therapy, potential alternative therapies targeting GAS6+-associated pathways, for example, CXCR4 antagonists, may be considered for GAS6+ patients to sensitize them to chemotherapy.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers, Tumor / genetics*
  • Cohort Studies
  • Cytogenetic Analysis
  • Female
  • Follow-Up Studies
  • Gene Expression Profiling
  • Humans
  • Intercellular Signaling Peptides and Proteins / genetics*
  • Leukemia, Myeloid, Acute / diagnosis
  • Leukemia, Myeloid, Acute / genetics*
  • Leukemia, Myeloid, Acute / mortality
  • Leukemia, Myeloid, Acute / therapy
  • Male
  • Middle Aged
  • Neoplasm Proteins / genetics
  • Oligonucleotide Array Sequence Analysis
  • Prognosis
  • Receptors, CXCR / genetics
  • Receptors, CXCR4 / genetics
  • Survival Rate
  • Trans-Activators
  • Tumor Suppressor Proteins / genetics
  • Young Adult

Substances

  • ACKR3 protein, human
  • BAALC protein, human
  • Biomarkers, Tumor
  • CXCR4 protein, human
  • Intercellular Signaling Peptides and Proteins
  • MN1 protein, human
  • Neoplasm Proteins
  • Receptors, CXCR
  • Receptors, CXCR4
  • Trans-Activators
  • Tumor Suppressor Proteins
  • growth arrest-specific protein 6