Molecular Determinants of Decitabine Response

该项目的长期目标是识别急性髓细胞白血病（AML）患者， 骨髓增生异常综合征（MDS），其最可能对地西他滨治疗有反应。地西他滨是一种 在MDS和AML中均有效的低甲基化剂。它可以作为一个门诊病人，它是很好的 在大多数患者中可以耐受。然而，响应率是适度的;即使有现代积极的时间表， 只有45%的患者达到完全缓解。地西他滨敏感性的分子基础和/或 阻力尚不清楚。 具体目标： 目标1.我们将定义地西他滨应答者的分子特征。我们将前瞻性地银行125 经适当同意的患者接受当前最先进的地西他滨方案治疗。我们将 通过外显子组测序和表达全面定义患者特异性分子特征 分析，使用基于mRNA和miRNA的阵列。我们将把基因分型和表达结果关联起来 包括对地西他滨治疗的反应性。这些研究将把基因组 DNMT 3A、IDH 1、IDH 2和TET 2的签名与结果。此外，全面、公正 分析将确定特异性分子标记是否与地西他滨应答相关。 目标二。我们将确定AML清除率和AML相关亚克隆的持续性是否与AML相关性相关。 对应于每种情况下AML的药物代谢、分子和/或临床特征。我们将评估 第0、10和28天患者特异性突变清除的速度，以及AML相关的持续性。 亚克隆尽管爆炸清除。我们将其与稳态地西他滨药物水平相关联， 总骨髓样本中甲基胞嘧啶的减少（有效给药的生物标志物）， 反应率和无事件生存率。 相关性（参见说明）： 许多患者对AML或MDS的地西他滨治疗无应答。敏感的原因和 阻力未知。在这项研究中，我们将优化一个管道，综合分子 患者特异性突变、表达谱和药理学结果的表征。我们将 确定分子标记是否预测地西他滨的反应或耐药性。

The long term goal of this project is to identify the patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) who are the most likely to respond to decitabine therapy. Decitabine is a hypomethylating agent that has efficacy in both MDS and AML. It can be given as an outpatient, and it is well tolerated in most patients. However, response rates are modest; even with modern aggressive schedules, only 4 5 % of patients achieve a complete response. The molecular basis of decitabine sensitivity and/or resistance is not yet clear. Specific Aims: Aim1.Wewilldefinethemolecularsignatureofdecitabineresponders.Wewillprospectivelybank125 properly consented patients treated with the current state-of-the-art decitabine protocol. We will comprehensively define patient-specific molecular signatures through exome sequencing and expression profiling, using both mRNA and miRNA based arrays. We will correlate genotyping and expression results with clinical features, including responsiveness to decitabine therapy. These studies will correlate genomic signatures of DNMT3A, I D H I , IDH2, and TET2 with outcomes. In addition, comprehensive, unbiased analysis will determine whether specific molecular signatures are associated with decitabine responses. Aim 2. We will determine whether the rate of AML clearance and persistence of AML-associated subclones corresponds tddrug metabolism, molecular, and/or clinical features of AML in each case. We will assess the velocity of patient-specific mutation clearance on day 0, 10, and 28, and the persistence of AML-associated subclones despite blast clearance. W e will correlate this with steiady-state decitabine drug levels, the reduction of methylcytosine in the total marrow sample (a biomarker of effective dosing), and with clinical response rates and event-free survival. RELEVANCE (See instructions): Many patients do not respond to decitabine therapy for AML or MDS. The causes of sensitivity and resistance are unknown. In this study we will optimize a pipeline for comprehensive molecular characterization of patient-specific mutations, expression profiles, and pharmacologic outcomes. We will determine whether molecular signatures predict response or resistance to decitabine.