Heterogeneity in mechanisms of emergent resistance in pediatric T-cell acute lymphoblastic leukemia

// Babasaheb D. Yadav 1,* , Amy L. Samuels 2,* , Julia E. Wells 2,* , Rosemary Sutton 3 , Nicola C. Venn 3 , Katerina Bendak 1 , Denise Anderson 4 , Glenn M. Marshall 5 , Catherine H. Cole 6 , Alex H. Beesley 2,** , Ursula R. Kees 2,** and Richard B. Lock 1,** 1 Leukaemia Biology Program, Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, Sydney, New South Wales, Australia 2 Division of Children's Leukaemia and Cancer Research, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia 3 Molecular Diagnostics, Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, Sydney, New South Wales, Australia 4 Division of Bioinformatics and Biostatistics, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia 5 Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia 6 School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia * Denotes Equal First Authorship ** Denotes Equal Senior Authorship Correspondence to: Richard B. Lock, email: // Keywords : acute lymphoblastic leukemia; relapse; drug resistance; xenograft; pre-clinical testing Received : June 08, 2016 Accepted : July 28, 2016 Published : August 11, 2016 Abstract Relapse in pediatric T-cell acute lymphoblastic leukemia (T-ALL) remains a significant clinical problem and is thought to be associated with clonal selection during treatment. In this study we used an established pre-clinical model of induction therapy to increase our understanding of the effect of engraftment and chemotherapy on clonal selection and acquisition of drug resistance in vivo . Immune-deficient mice were engrafted with patient diagnostic specimens and exposed to a repeated combination therapy consisting of vincristine, dexamethasone, L-asparaginase and daunorubicin. Any re-emergence of disease following therapy was shown to be associated with resistance to dexamethasone, no resistance was observed to the other three drugs. Immunoglobulin/T-cell receptor gene rearrangements closely matched those in respective diagnosis and relapse patient specimens, highlighting that these clonal markers do not fully reflect the biological changes associated with drug resistance. Gene expression profiling revealed the significant underlying heterogeneity of dexamethasone-resistant xenografts. Alterations were observed in a large number of biological pathways, yet no dominant signature was common to all lines. These findings indicate that the biological changes associated with T-ALL relapse and resistance are stochastic and highly individual, and underline the importance of using sophisticated molecular techniques or single cell analyses in developing personalized approaches to therapy.