Abstract
Flt3 is a tyrosine kinase receptor expressed on hematopoietic cells. Activating mutations of this receptor are encountered in over one-fourth of acute myelogenous leukemia (AML) cases and activate multiple intracellular pathways leading to cell proliferation, inhibition of apoptosis, and blockage of differentiation in leukemic blasts. AML with flt3 mutations has a worse prognosis than AML with normal flt3, at least in younger patients. Sevaral flt3 inhibitors are in various stages of preclinical and clinical development and it is hoped that specific therapies against AML with flt3 mutations will soon be available to the clinician.
Similar content being viewed by others
References
Gilliland, D.G. and Griffin, J.D. (2002). The roles of FLT3 in hematopoiesis and leukemia. Blood 100:1532–1542.
Kiyoi, H. and Naoe, T. (2002). FLT3 in human hematologic malignancies. Leuk. Lymphoma 43:1541–1547.
Testa, U., et al. (2002). Human acute stem cell leukemia with multilineage differentiation potential via cascade activation of growth factor receptors. Blood 99:4634–4637.
Tse, K.F., Mukherjee, G. and Small, D. (2000). Constitutive activation of FLT3 stimulates multiple intracellular signal transducers and results in transformation. Leukemia 14:1766–1776.
Matthews, W., Jordan, C.T., Wiegand, G.W., Pardoll, D. and Lemischka, I.R. (1991). A receptor tyrosine kinase specific to hematopoietic stem and progenitor cell-enriched populations. Cell 65:1143–1152.
Rosnet, O., Marchetto, S., deLapeyriere, O., and Birnbaum, D. (1991). Murine Flt3, a gene encoding a novel tyrosine kinase receptor of the PDGFR/CSF1R family. Oncogene 6:1641–1650.
Lyman, S.D., et al. (1993). Characterization of the protein encoded by the flt3 (flk2) receptor-like tyrosine kinase gene. Oncogene 8:815–822.
Abu-Duhier, F.M., et al. (2001). Genomic structure of human FLT3: implications for mutational analysis. Br. J. Haematol. 113:1076–1077.
Lyman, S.D. and Jacobsen, S.E. (1998). c-kit ligand and Flt3 ligand: stem/progenitor cell factors with overlapping yet distinct activities. Blood 91:1101–1134.
Christensen, J.L. and Weissman, I.L. (2001). Flk-2 is a marker in hematopoietic stem cell differentiation: a simple method to isolate long-term stem cells. Proc. Natl. Acad. Sci. USA 98:14,541–14,546.
Ebihara, Y., et al. (2002). Reconstitution of human haematopoiesis in non-obese diabetic/severe combined immunodeficient mice by clonal cells expanded from single CD34+. Br. J. Haematol. 119:525–534.
Fichelson, S. (1998). The FLT3/FLK2 ligand: structure, functions and prospects. Eur. Cytokine Netw. 9:7–22.
Lavagna-Sevenier, C., Marchetto, S., Birnbaum, D. and Rosnet, O. (1998). FLT3 signaling in hematopoietic cells involves CBL, SHC and an unknown P115 as prominent tyrosine-phosphorylated substrates. Leukemia 12:301–310.
Scheijen, B. and Griffin, J.D. (2002). Tyrosine kinase oncogenes in normal hematopoiesis and hematological disease. Oncogene 21:3314–3333.
Mizuki, M., et al. (2000). Flt3 mutations from patients with acute myeloid leukemia induce transformation of 32D cells mediated by the Ras and STAT5 pathways. Blood 96:3907–3914.
Kerkhoff, E. and Rapp, U.R. (1998). Cell cycle targets of Ras/Raf signalling. Oncogene 17:1457–1462.
Reuther, G.W. and Der, C.J. (2000). The Ras branch of small GTPases: Ras family members don’t fall far from the tree. Curr. Opin. Cell Biol. 12:157–165.
Vivanco, I. and Sawyers, C.L. (2002). The phosphatidylinositol 3-kinase AKT pathway in human cancer. Nature Rev. Cancer 2:489–501.
Cardone, M.H., et al. (1998). Regulation of cell death protease caspase-9 by phosphorylation. Science 282:1318–1321.
Zhang, S., et al. (2000). Essential role of signal transducer and activator of transcription (Stat)5a but not Stat5b for Flt3-dependent signaling. J. Exp. Med. 192:719–728.
Rane, S.G. and Reddy, E.P. (2002). JAKs, STATs and Src kinases in hematopoiesis. Oncogene 21:3334–3358.
Birkenkamp, K.U., Geugien, M., Lemmink, H.H., Kruijer, W. and Vellenga, E. (2001) Regulation of constitutive STAT5 phosphorylation in acute myeloid leukemia blasts. Leukemia 15:1923–1931.
Marchetto, S., et al. (1999). SHC and SHIP phosphorylation and interaction in response to activation of the FLT3 receptor. Leukemia 13:1374–1382.
Mizuki, M., et al. (2003). Suppression of myeloid transcription factors and induction of STAT response genes by AML-specific Flt3 mutations. Blood, 101:3164–3173.
Chen, X.P., et al. (2002). Pim serine/threonine kinases regulate the stability of Socs-1 protein. Proc. Natl. Acad. Sci. USA 99:2175–2180.
Allen, J.D., Verhoeven, E., Domen, J., van der Valk, M. and Berns, A. (1997). Pim-2 transgene induces lymphoid tumors, exhibiting potent synergy with c-myc. Oncogene 15:1133–1141.
Wolf, I. and Rohrschneider, L.R. (1999). Fiz1, a novel zinc finger protein interacting with the receptor tyrosine kinase Flt3. J. Biol. Chem. 274:21,478–21,484.
Serve, H., Flesch, K., Serve, S., Fenski, R. and Berdel, W.E. (1999). Expression and function of Flt3/flk2 in human tumor cell lines. Int. J. Oncol. 14:765–770.
Drexler, H.G. (1996). Expression of FLT3 receptor and response to FLT3 ligand by leukemic cells. Leukemia 10:588–599.
Stacchini, A., et al. (1996). Expression of type III receptor tyrosine kinases FLT3 and KIT and responses to their ligands by acute myeloid leukemia blasts. Leukemia 10:1584–1591.
Turner, A.M., Lin, N.L., Issarachai, S., Lyman, S.D. and Broudy, V.C. (1996). FLT3 receptor expression on the surface of normal and malignant human hematopoietic cells. Blood 88:3383–3390.
Lisovsky, M., et al. (1996). Flt3 ligand stimulates proliferation and inhibits apoptosis of acute myeloid leukemia cells: regulation of Bcl-2 and Bax. Blood 88:3987–3997.
Nakao, M.J., Janssen, W., Erz, D., Seriu, T. and Bartram C.R. (2000). Tandem duplication of the FLT3 gene in acute lymphoblastic leukemia: a marker for the monitoring of minimal residual disease. Leukemia 14:522–524.
Yokota, S., et al. (1997). Internal tandem duplication of the FLT3 gene is preferentially seen in acute myeloid leukemia and myelodysplastic syndrome among various hematological malignancies. A study on a large series of patients and cell lines. Leukemia 11:1605–1609.
Horiike, S., et al. (1997). Tandem duplications of the FLT3 receptor gene are associated with leukemic transformation of myelodysplasia. Leukemia 11:1442–1446.
Nakao, M., et al. (1996). Internal tandem duplication of the flt3 gene found in acute myeloid leukemia. Leukemia 10:1911–1918.
Kottaridis, P.D., et al. (2002). Studies of FLT3 mutations in paired presentation and relapse samples from patients with acute myeloid leukemia: implications for the role of FLT3 mutations in leukemogenesis, minimal residual disease detection, and possible therapy with FLT3 inhibitors. Blood 100:2393–2398.
Kiyoi, H., Ohno, R., Ueda, R., Saito, H. and Naoe, T. (2002). Mechanism of constitutive activation of FLT3 with internal tandem duplication in the juxtamembrane domain. Oncogene 21:2555–2563.
Hayakawa, F., et al. (2000). Tandem-duplicated Flt3 constitutively activates STAT5 and MAP kinase and introduces autonomous cell growth in IL-3-dependent cell lines. Oncogene 19:624–631.
Kiyoi, H., et al. (1998). Internal tandem duplication of the FLT3 gene is a novel modality of elongation mutation which causes constitutive activation of the product. Leukemia 12:1333–1337.
Zheng, R., Friedman, A.D. and Small, D. (2002). Targeted inhibition of FLT3 overcomes the block to myeloid differentiation in 32Dcl3 cells caused by expression of FLT3/ITD mutations. Blood 100:4154–4161.
Abu-Duhier, F.M., et al. (2001). Identification of novel FLT-3 Asp835 mutations in adult acute myeloid leukaemia. Br. J. Haematol. 113:983–988.
Thiede, C., et al. (2002). Analysis of FLT3-activating mutations in 979 patients with acute myelogenous leukemia: association with FAB subtypes and identification of subgroups with poor prognosis. Blood 99:4326–4335.
Yamamoto, Y., et al. (2001). Activating mutation of D835 within the activation loop of FLT3 in human hematologic malignancies. Blood 97:2434–2439.
Griffin, J.D. (2001). Point mutations in the FLT3 gene in AML. Blood 97:2193.
Spiekermann, K., et al. (2002). A new and recurrent activating length mutation in exon 20 of the FLT3 gene in acute myeloid leukemia. Blood 100:3423–3425.
Fenski, R., et al. (2000). Constitutive activation of FLT3 in acute myeloid leukaemia and its consequences for growth of 32D cells. Br. J. Haematol. 108:322–330.
Kelly, L.M., et al. (2002). FLT3 internal tandem duplication mutations associated with human acute myeloid leukemias induce myeloproliferative disease in a murine bone marrow transplant model. Blood 99:310–318.
Kelly, L.M., et al. (2002). PML/RARalpha and FLT3-ITD induce an APL-like disease in a mouse model. Proc. Natl. Acad. Sci. USA 99:8283–8288.
Kottaridis, P.D., et al. (2001). The presence of a FLT3 internal tandem duplication in patients with acute myeloid leukemia (AML) adds important prognostic information to cytogenetic risk group and response to the first cycle of chemotherapy: analysis of 854 patients from the United Kingdom Medical Research Council AML 10 and 12 trials. Blood 98:1752–1759.
Kiyoi, H., et al. (1999). Prognostic implication of FLT3 and N-RAS gene mutations in acute myeloid leukemia. Blood 93:3074–3080.
Kondo, M., et al. (1999). Prognostic value of internal tandem duplication of the FLT3 gene in childhood acute myelogenous leukemia. Med. Pediatr. Oncol. 33:525–529.
Liang, D.C., et al. (2002). Clinical relevance of internal tandem duplication of the FLT3 gene in childhood acute myeloid leukemia. Cancer 94:3292–3298.
Meshinchi, S., et al. (2001). Prevalence and prognostic significance of Flt3 internal tandem duplication in pediatric acute myeloid leukemia. Blood 97:89–94.
Schnittger, S., et al. (2002). Analysis of FLT3 length mutations in 1003 patients with acute myeloid leukemia: correlation to cytogenetics, FAB subtype, and prognosis in the AMLCG study and usefulness as a marker for the detection of minimal residual disease. Blood 100:59–66.
Rowe, J.M. (2000). Treatment of acute myelogenous leukemia in older adults. Leukemia 14:480–487.
Inokuchi, K., et al. (2002). Loss of DCC gene expression is of prognostic importance in acute myelogenous leukemia. Clin. Cancer Res. 8:1882–1888.
Rombouts, W.J., Blokland, I., Lowenberg, B. and Ploemacher, R.E. (2000). Biological characteristics and prognosis of adult acute myeloid leukemia with internal tandem duplications in the Flt3 gene. Leukemia 14:675–683.
Abu-Duhier, F.M., et al. (2000). FLT3 internal tandem duplication mutations in adult acute myeloid leukaemia define a high-risk group. Br. J. Haematol. 111:190–195.
Stirewalt, D.L., et al. (2001). FLT3, RAS, and TP53 mutations in elderly patients with acute myeloid leukemia. Blood 97:3589–3595.
Whitman, S.P., et al. (2001). Absence of the wild-type allele predicts poor prognosis in adult de novo acute myeloid leukemia with normal cytogenetics and the internal tandem duplication of FLT3: a cancer and leukemia group B study. Cancer Res. 61:7233–7239.
Boissel, N., et al. (2002). Prognostic significance of FLT3 internal tandem repeat in patients with de novo acute myeloid leukemia treated with reinforced courses of chemotherapy. Leukemia 16:1699–1704.
Preudhomme, C., et al. (2002). Favorable prognostic significance of CEBPA mutations in patients with de novo acute myeloid leukemia: a study from the Acute Leukemia French Association (ALFA). Blood 100:2717–2723.
Iwai, T., et al. (1999). Internal tandem duplication of the FLT3 gene and clinical evaluation in childhood acute myeloid leukemia. The Children’s Cancer and Leukemia Study Group, Japan. Leukemia 13:38–43.
Arrigoni, P., et al. (2003). FLT3 internal tandem duplication in childhood acute myeloid leukemia: association with hyperleukocytosis in acute promyelocytic leukemia. Br. J. Haematol. 120:89–92.
Asou, N., et al. (2001). Analysis of prognostic factors in newly diagnosed patients with acute promyelocytic leukemia: the APL92 study of the Japan Adult Leukemia Study Group (JALSG). Cancer Chemother. Pharmacol. 48(Suppl. 1):S65-S71.
Hochhaus, A., et al. (2000). Detection and quantification of residual disease in chronic myelogenous leukemia. Leukemia 14:998–1005.
Serrano, J., et al. (2000). Molecular analysis of lineage-specific chimerism and minimal residual disease by RTPCR of p210(BCR-ABL) and p190(BCR-ABL) after allogeneic bone marrow transplantation for chronic myeloid leukemia: increasing mixed myeloid chimerism and p190(BCR-ABL) detection precede cytogenetic relapse. Blood 95:2659–2665.
Stirewalt, D.L., Willman, C.L. and Radich, J.P. (2001). Quantitative, real-time polymerase chain reactions for FLT3 internal tandem duplications are highly sensitive and specific. Leuk. Res. 25:1085–1088.
Shih, L.Y., et al. (2002). Internal tandem duplication of FLT3 in relapsed acute myeloid leukemia: a comparative analysis of bone marrow samples from 108 adult patients at diagnosis and relapse. Blood 100:2387–2392.
Hovland, R., Gjertsen, B.T. and Bruserud, O. (2002). Acute myelogenous leukemia with internal tandem duplication of the Flt3 gene appearing or altering at the time of relapse: a report of two cases. Leuk. Lymphoma 43:2027–2029.
Nakano, Y., et al. (1999). Molecular evolution of acute myeloid leukaemia in relapse: unstable N-ras and FLT3 genes compared with p53 gene. Br. J. Haematol. 104:659–664.
Gilliland, D.G. (2002). Murky waters for MRD detection in AML: flighty FLT3/ITDs. Blood 100:2277.
Okada, H., et al. (1998). AML1(-/-) embryos do not express certain hematopoiesis-related gene transcripts including those of the PU.1 gene. Oncogene 17:2287–2293.
Frohling, S., et al. (2002). Prognostic significance of activating FLT3 mutations in younger adults (16 to 60 years) with acute myeloid leukemia and normal cytogenetics: a study of the AML Study Group Ulm (AMLSG ULM). Blood 100:4372–4380.
Sawyers, C.L. (2002). Finding the next Gleevec: FLT3 targeted kinase inhibitor therapy for acute myeloid leukemia. Cancer Cell 1:413–415.
Propper, D.J., et al. (2001). Phase I and pharmacokinetic study of PKC412, an inhibitor of protein kinase C. J. Clin. Oncol. 19:1485–1492.
Weisberg, E., et al. (2002). Inhibition of mutant FLT3 receptors in leukemia cells by the small molecule tyrosine kinase inhibitor PKC412. Cancer Cell 1:433–443.
Yee, K.W., et al. (2002). SU5416 and SU5614 inhibit kinase activity of wild-type and mutant FLT3 receptor tyrosine kinase. Blood 100:2941–2949.
Spiekermann, K., et al. (2003). The protein tyrosine kinase inhibitor SU5614 inhibits FLT3 and induces growth arrest and apoptosis in AML-derived cell lines expressing a constitutively activated FLT3. Blood, 101:1494–1504.
Smolich, B.D., et al. (2001). The antiangiogenic protein kinase inhibitors SU5416 and SU6668 inhibit the SCF receptor (c-kit) in a human myeloid leukemia cell line and in acute myeloid leukemia blasts. Blood 97:1413–1421.
Stopeck, A., et al. (2002). Results of a phase I dose-escalating study of the antiangiogenic agent, SU5416, in patients with advanced malignancies. Clin. Cancer Res. 8:2798–2805.
Mesters, R.M., et al. (2001). Stable remission after administration of the receptor tyrosine kinase inhibitor SU5416 in a patient with refractory acute myeloid leukemia. Blood 98:241–243.
Levis, M., et al. (2002). A FLT3-targeted tyrosine kinase inhibitor is cytotoxic to leukemia cells in vitro and in vivo. Blood 99:3885–3891.
Kelly, L.M., et al. (2002). CT53518, a novel selective FLT3 antagonist for the treatment of acute myelogenous leukemia (AML). Cancer Cell 1:421–432.
Levis, M., Tse, K.F., Smith, B.D., Garrett, E. and Small, D. (2001). A FLT3 tyrosine kinase inhibitor is selectively cytotoxic to acute myeloid leukemia blasts harboring FLT3 internal tandem duplication mutations. Blood 98:885–887.
Teller, S., et al. (2002). Bis(1H-2-indolyl)-1-methanones as inhibitors of the hematopoietic tyrosine kinase Flt3. Leukemia 16:1528–1534.
Tse, K.F., et al. (2002). Inhibition of the transforming activity of FLT3 internal tandem duplication mutants from AML patients by a tyrosine kinase inhibitor. Leukemia 16:2027–2036.
Minami, Y., et al. (2002). Selective apoptosis of tandemly duplicated FLT3-transformed leukemia cells by Hsp90 inhibitors. Leukemia 16:1535–1540.
Naoe, T., et al. (2001). FLT3 tyrosine kinase as a target molecule for selective antileukemia therapy. Cancer Chemother. Pharmacol. 48(Suppl. 1):S27-S30.
Zhao, M., et al. (2000). In vivo treatment of mutant FLT3-transformed murine leukemia with a tyrosine kinase inhibitor. Leukemia 14:374–378.
Mackarehtschian, K., et al. (1995). Targeted disruption of the flk2/flt3 gene leads to deficiencies in primitive hematopoietic progenitors. Immunity 3:147–161.
Shaw, S.G., Maung, A.A., Steptoe, R.J., Thomson, A.W. and Vujanovic, N.L. (1998). Expansion of functional NK cells in multiple tissue compartments of mice treated with Flt3-ligand: implications for anti-cancer and anti-viral therapy. J. Immunol. 161:2817–2824.
Chen, K., et al. (1997). Antitumor activity and immunotherapeutic properties of Flt3-ligand in a murine breast cancer model. Cancer Res. 57:3511–3516.
Lynch, D.H., et al. (1997). Flt3 ligand induces tumor regression and antitumor immune responses in vivo. Nature Med. 3:625–631.
Wang, A., Braun, S.E., Sonpavde, G. and Cornetta, K. (2000). Antileukemic activity of Flt3 ligand in murine leukemia. Cancer Res. 60:1895–1900.
Costello, R.T., et al. (2002). Defective expression and function of natural killer cell-triggering receptors in patients with acute myeloid leukemia. Blood 99:3661–3667.
Druker, B.J., et al. (2001). Activity of a specific inhibitor of the BCR-ABL tyrosine kinase in the blast crisis of chronic myeloid leukemia and acute lymphoblastic leukemia with the Philadelphia chromosome. N. Engl. J. Med. 344:1038–1042.
Druker, B.J., et al. (2001). Efficacy and safety of a specific inhibitor of the BCR-ABL tyrosine kinase in chronic myeloid leukemia. N. Engl. J. Med. 344:1031–1037.
Voutsadakis, I.A. (2001). The STI571 for the treatment of chronic myelogenous leukemia. Iatriki 80:167–171.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Voutsadakis, I.A. Flt3 in acute myelogenous leukemia. Med Oncol 20, 311–323 (2003). https://doi.org/10.1385/MO:20:4:311
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1385/MO:20:4:311