Patients with Fanconi anemia (FA) have a high risk of developing acute myeloid leukemia (AML). In this study, we attempted to identify cell-surface markers for leukemia-initiating cells in FA-AML patients. We found that the IL-3 receptor-␣ (IL-3R␣) is a promising candidate as an leukemia-initiating cell-specific antigen for FA-AML. Whereas IL-3R␣ expression is undetectable on normal CD34 ؉ CD38 ؊ HSCs, it is overexpressed on CD34 ؉ CD38 ؊ cells from FA patients with AML.
IntroductionAcute myeloid leukemia (AML), a heterogeneous group of hematologic malignancies characterized by an accumulation of clonal myeloid progenitor cells that do not differentiate normally, 1,2 comprises approximately 25% of childhood acute leukemias. 3 The treatment of AML remains a challenge, and most AML patients will die of their disease within 1-2 years of diagnosis. 4 Conventional chemotherapeutic agents have been successful to some degree in treating AML, but now appear to have reached their maximum potential. Even with high-dose chemotherapy, only 30%-40% of AML patients survive, which is due mainly to relapse of the disease. 5 Recently, novel therapeutic strategies for AML have focused on immune-based therapy through monoclonal antibodies that target and destroy leukemic blasts via specific cell receptors. 6,7 These therapies were designed with the aim of selectively killing malignant cells that express unique antigens while sparing normal cells.One of the recent advances in the AML field is the postulation that AML arises from a rare population of leukemic stem cells (LSCs). 8,9 Phenotypic and functional analyses show that LSCs reside in the CD34 ϩ CD38 Ϫ compartment, the primitive stem/ progenitor population that also contains normal HSCs. 10 Further studies demonstrated that both normal HSCs and LSCs share the properties of quiescence and self-renewal. [8][9][10] This relatively dormant property of LSCs may contribute to the pattern of remission and subsequent relapse that is typical of the response to cytotoxic chemotherapy in AML. Therefore, it is believed that although most AML blasts can be eradicated by cytotoxic therapy, LSCs may be resistant to killing by chemotherapeutic agents. Recent studies have suggested that several antigens, such as CD33, CD44, CD96, CD123, and CLL-1, are specifically expressed in AML LSCs but not in normal HSCs. [11][12][13][14][15][16][17] Because it is believed that LSCs are the most relevant target population for novel antileukemic therapy, these unique antigens present opportunities for selectively targeting AML LSCs.One of the best studied AML models is Fanconi anemia (FA), a genetic disorder associated with bone marrow failure, clonal proliferation of HSCs and progenitor cells, and progression to myelodysplastic syndrome (MDS) and AML. [18][19][20] FA is caused by a deficiency in any of the 14 genes that encode the FANCA, FANCB, FANCC, FANCD1/BRCA2, FANCD2, FANCE, FANCF, FANCG, FANCI, FANCJ/BRIP1, FANCL, FANCM, FANCN/PALB2, and FANCO/RAD51C proteins. [21][22][23][24] The biologic function ...