# Therapeutic targeting of FLT3 and associated drug resistance in acute myeloid leukemia

**Authors:** Melat T. Gebru, Hong-Gang Wang

PMC · DOI: 10.1186/s13045-020-00992-1 · Journal of Hematology & Oncology · 2020-11-19

## TL;DR

This paper reviews how targeting FLT3 in AML is promising but faces challenges due to drug resistance and relapse.

## Contribution

The paper provides a comprehensive overview of FLT3 inhibitor resistance mechanisms in AML.

## Key findings

- FLT3 mutations are linked to poor outcomes in AML patients.
- Despite initial success, FLT3 inhibitors often lead to relapse due to resistance.
- Understanding resistance mechanisms is crucial for improving AML treatment.

## Abstract

Acute myeloid leukemia (AML) is a heterogeneous disease caused by several gene mutations and cytogenetic abnormalities affecting differentiation and proliferation of myeloid lineage cells. FLT3 is a receptor tyrosine kinase commonly overexpressed or mutated, and its mutations are associated with poor prognosis in AML. Although aggressive chemotherapy often followed by hematopoietic stem cell transplant is the current standard of care, the recent approval of FLT3-targeted drugs is revolutionizing AML treatment that had remained unchanged since the 1970s. However, despite the dramatic clinical response to targeted agents, such as FLT3 inhibitors, remission is almost invariably short-lived and ensued by relapse and drug resistance. Hence, there is an urgent need to understand the molecular mechanisms driving drug resistance in order to prevent relapse. In this review, we discuss FLT3 as a target and highlight current understanding of FLT3 inhibitor resistance.

## Linked entities

- **Genes:** FLT3 (fms related receptor tyrosine kinase 3) [NCBI Gene 2322]
- **Diseases:** acute myeloid leukemia (MONDO:0015667), AML (MONDO:0018874)

## Full-text entities

- **Genes:** CYP3A4 (cytochrome P450 family 3 subfamily A member 4) [NCBI Gene 1576] {aka CP33, CP34, CYP3A, CYP3A3, CYPIIIA3, CYPIIIA4}, ABCB1 (ATP binding cassette subfamily B member 1) [NCBI Gene 5243] {aka ABC20, CD243, CLCS, ENPAT, GP170, MDR1}, Flt3 (FMS-like tyrosine kinase 3) [NCBI Gene 14255] {aka B230315G04, CD135, Flk-2, Flk2, Flt-3, Ly72}, KMT2A (lysine methyltransferase 2A) [NCBI Gene 4297] {aka ALL-1, ALL1, CXXC7, GAS7, HRX, HTRX}, IDH2 (isocitrate dehydrogenase (NADP(+)) 2) [NCBI Gene 3418] {aka D2HGA2, ICD-M, IDH, IDH-2, IDHM, IDP}, IL3 (interleukin 3) [NCBI Gene 3562] {aka IL-3, MCGF, MULTI-CSF}, EGFR (epidermal growth factor receptor) [NCBI Gene 1956] {aka ERBB, ERBB1, ERRP, HER1, NISBD2, NNCIS}, AXL (AXL receptor tyrosine kinase) [NCBI Gene 558] {aka ARK, AXL3, JTK11, Tyro7, UFO}, CD38 (CD38 molecule) [NCBI Gene 952] {aka ADPRC 1, ADPRC1, cADPR1}, PDGFRB (platelet derived growth factor receptor beta) [NCBI Gene 5159] {aka CD140B, IBGC4, IMF1, JTK12, KOGS, OPDKD}, GRB2 (growth factor receptor bound protein 2) [NCBI Gene 2885] {aka ASH, EGFRBP-GRB2, Grb3-3, MST084, MSTP084, NCKAP2}, KIT (KIT proto-oncogene, receptor tyrosine kinase) [NCBI Gene 3815] {aka C-Kit, CD117, MASTC, PBT, SCFR}, JAK2 (Janus kinase 2) [NCBI Gene 3717] {aka JTK10}, MAPK1 (mitogen-activated protein kinase 1) [NCBI Gene 5594] {aka ERK, ERK-2, ERK2, ERT1, MAPK2, NS13}, PIK3R1 (phosphoinositide-3-kinase regulatory subunit 1) [NCBI Gene 5295] {aka AGM7, GRB1, IMD36, p85, p85-ALPHA, p85alpha}, TYK2 (tyrosine kinase 2) [NCBI Gene 7297] {aka IMD35, JTK1}, CCNL2 (cyclin L2) [NCBI Gene 81669] {aka ANIA-6B, CCNM, CCNS, HCLA-ISO, HLA-ISO, PCEE}, RELA (RELA proto-oncogene, NF-kB subunit) [NCBI Gene 5970] {aka AIF3BL3, CMCU, NFKB3, p65}, CXCL12 (C-X-C motif chemokine ligand 12) [NCBI Gene 6387] {aka IRH, PBSF, SCYB12, SDF1, TLSF, TPAR1}, STAT5A (signal transducer and activator of transcription 5A) [NCBI Gene 6776] {aka MGF, STAT5}, FLT3LG (fms related receptor tyrosine kinase 3 ligand) [NCBI Gene 2323] {aka FL, FLG3L, FLT3L, IMD125}, RET (ret proto-oncogene) [NCBI Gene 5979] {aka CDHF12, CDHR16, HSCR1, MEN2A, MEN2B, MTC1}, SHC1 (SHC adaptor protein 1) [NCBI Gene 6464] {aka SHC, SHCA}, RAC1 (Rac family small GTPase 1) [NCBI Gene 5879] {aka MIG5, MRD48, Rac-1, TC-25, p21-Rac1}, HMGB1 (high mobility group box 1) [NCBI Gene 3146] {aka HMG-1, HMG1, HMG3, SBP-1}, CDKN1A (cyclin dependent kinase inhibitor 1A) [NCBI Gene 1026] {aka CAP20, CDKN1, CIP1, MDA-6, P21, SDI1}, SELE (selectin E) [NCBI Gene 6401] {aka CD62E, ELAM, ELAM1, ESEL, LECAM2, selectin-e}, TNF (tumor necrosis factor) [NCBI Gene 7124] {aka DIF, IMD127, TNF-alpha, TNFA, TNFSF2, TNLG1F}, CD34 (CD34 molecule) [NCBI Gene 947], BCL2 (BCL2 apoptosis regulator) [NCBI Gene 596] {aka Bcl-2, PPP1R50}, MTOR (mechanistic target of rapamycin kinase) [NCBI Gene 2475] {aka FRAP, FRAP1, FRAP2, RAFT1, RAPT1, SKS}, MCL1 (MCL1 apoptosis regulator, BCL2 family member) [NCBI Gene 4170] {aka BCL2L3, EAT, MCL1-ES, MCL1L, MCL1S, Mcl-1}, NRAS (NRAS proto-oncogene, GTPase) [NCBI Gene 4893] {aka ALPS4, CMNS, N-ras, NCMS, NRAS1, NS6}, SRC (SRC proto-oncogene, non-receptor tyrosine kinase) [NCBI Gene 6714] {aka ASV, SRC1, THC6, c-SRC, p60-Src}, DNMT3A (DNA methyltransferase 3 alpha) [NCBI Gene 1788] {aka DNMT3A2, HESJAS, M.HsaIIIA, TBRS}, IL1B (interleukin 1 beta) [NCBI Gene 3553] {aka IL-1, IL1-BETA, IL1F2, IL1beta}, ABL1 (ABL proto-oncogene 1, non-receptor tyrosine kinase) [NCBI Gene 25] {aka ABL, BCR-ABL, CHDSKM, JTK7, bcr/abl, c-ABL}, TXK (TXK tyrosine kinase) [NCBI Gene 7294] {aka BTKL, PSCTK5, PTK4, RLK, TKL}, AKT1 (AKT serine/threonine kinase 1) [NCBI Gene 207] {aka AKT, PKB, PKB-ALPHA, PRKBA, RAC, RAC-ALPHA}, DUSP5 (dual specificity phosphatase 5) [NCBI Gene 1847] {aka DUSP, HVH3}, CDK1 (cyclin dependent kinase 1) [NCBI Gene 983] {aka CDC2, CDC28A, P34CDC2}, CREB1 (cAMP responsive element binding protein 1) [NCBI Gene 1385] {aka CREB, CREB-1}, FGF2 (fibroblast growth factor 2) [NCBI Gene 2247] {aka BFGF, FGF-2, FGFB, HBGF-2}, NPM1 (nucleophosmin 1) [NCBI Gene 4869] {aka B23, NPM}, FLT3 (fms related receptor tyrosine kinase 3) [NCBI Gene 2322] {aka CD135, FLK-2, FLK2, STK1}, RPS6KB1 (ribosomal protein S6 kinase B1) [NCBI Gene 6198] {aka PS6K, S6K, S6K-beta-1, S6K1, STK14A, p70 S6KA}, VEGFA (vascular endothelial growth factor A) [NCBI Gene 7422] {aka L-VEGF, MVCD1, VEGF, VPF}, IGF1 (insulin like growth factor 1) [NCBI Gene 3479] {aka IGF, IGF-I, IGFI, MGF}, PIM1 (Pim-1 proto-oncogene, serine/threonine kinase) [NCBI Gene 5292] {aka PIM}, IDH1 (isocitrate dehydrogenase (NADP(+)) 1) [NCBI Gene 3417] {aka HEL-216, HEL-S-26, IDCD, IDH, IDP, IDPC}, CBL (Cbl proto-oncogene) [NCBI Gene 867] {aka C-CBL, CBL2, FRA11B, NSLL, RNF55}, RUNX1T1 (RUNX1 partner transcriptional co-repressor 1) [NCBI Gene 862] {aka AML1-MTG8, AML1T1, CBFA2T1, CDR, ETO, MTG8}, CREBBP (CREB binding lysine acetyltransferase) [NCBI Gene 1387] {aka CBP, KAT3A, MKHK1, RSTS, RSTS1}, IL10 (interleukin 10) [NCBI Gene 3586] {aka CSIF, GVHDS, IL-10, IL10A, TGIF}, BRAF (B-Raf proto-oncogene, serine/threonine kinase) [NCBI Gene 673] {aka B-RAF1, B-raf, BRAF-1, BRAF1, NS7, RAFB1}, MYC (MYC proto-oncogene, bHLH transcription factor) [NCBI Gene 4609] {aka MRTL, MYCC, bHLHe39, c-Myc}, JUNB (JunB proto-oncogene, AP-1 transcription factor subunit) [NCBI Gene 3726] {aka AP-1}, CSF2 (colony stimulating factor 2) [NCBI Gene 1437] {aka CSF, GMCSF}, PRRT2 (proline rich transmembrane protein 2) [NCBI Gene 112476] {aka BFIC2, BFIS2, DSPB3, DYT10, EKD1, FICCA}, NOTCH1 (notch receptor 1) [NCBI Gene 4851] {aka AOS5, AOVD1, TAN1, hN1}
- **Diseases:** metastasis (MESH:D009362), Leukemia (MESH:D007938), SCID (MESH:D053632), aggressiveness (MESH:D010554), inflammation (MESH:D007249), Relapse (MESH:D012008), TKD (MESH:C566928), abnormalities (MESH:D000014), DTPs (MESH:D056486), cytogenetic (MESH:D002869), ITD (MESH:D000082122), cancer (MESH:D009369), hematological malignancy (MESH:D019337), nonsmall cell lung cancer (MESH:D002289), fatigue (MESH:D005221), SHC (MESH:D006086), diarrhea (MESH:D003967), melanoma (MESH:D008545), B- and T-ALL (MESH:D015452), AML (MESH:D015470), acute lymphoblastic leukemia (MESH:D054198), Mixed lineage leukemia (MESH:D015456), myeloma (MESH:D009101), acneiform rash (MESH:D005076), lung cancer (MESH:D008175), anemia (MESH:D000740)
- **Chemicals:** CGP 52421 (MESH:C586021), LPS (MESH:D008070), tyrosine (MESH:D014443), ASP2215 (MESH:C000609080), crenolanib (MESH:C577197), BAD (MESH:C006711), CGP 62221 (MESH:C586020), glycine (MESH:D005998), Midostaurin (MESH:C059539), Sorafenib (MESH:D000077157), Quizartinib (MESH:C544967), ROS (MESH:D017382), Sunitinib (MESH:D000077210), staurosporine (MESH:D019311), ATP (MESH:D000255), DFG (-), ponatinib (MESH:C545373),  (MESH:D000970),  (MESH:D051941),  (MESH:D047428),  (MESH:C497970)
- **Species:** Moloney murine leukemia virus (no rank) [taxon 11801], Homo sapiens (human, species) [taxon 9606], Mus musculus (house mouse, species) [taxon 10090]
- **Mutations:** D835, K429E, F691L, N676K, tyrosine residues with phenylalanine, F691, Y842D, BRAFV600E, Y842
- **Cell lines:** Ba/F3 — Mus musculus (Mouse), Factor-dependent cell line (CVCL_0161)

## Full text

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## Figures

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## References

116 references — full list in the complete paper: https://tomesphere.com/paper/PMC7678146/full.md

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Source: https://tomesphere.com/paper/PMC7678146