bims-tremyl Biomed News
on Therapy resistance biology in myeloid leukemia
Issue of 2026–11–01
25 papers selected by
Paolo Gallipoli, Barts Cancer Institute, Queen Mary University of London



  1. J Clin Invest. 2026 Oct 29. pii: e201732. [Epub ahead of print]
      ASXL1 mutations confer a poor prognosis in myeloid neoplasms, including in CALR-mutated myeloproliferative neoplasms (MPN). We generated Calr-Asxl1 co-mutant mice and found more severe thrombocytosis and increased splenomegaly, compared with Calr single-mutant animals. Calr-Asxl1 co-mutant megakaryocytes displayed more pronounced morphological abnormalities and enhanced emperipolesis characteristic of inflammation. Concordant with this, a differentiation trajectory directly to megakaryocytes from hematopoietic stem cells (HSC) was more prominent in Calr-Asxl1 co-mutant mice. In this non-canonical trajectory, where megakaryocyte-biased HSCs directly differentiate into megakaryocyte progenitors, we found upregulation of Mef2c, a key transcriptional regulator of megakaryocyte lineage commitment. Mature Calr-Asxl1 co-mutant megakaryocytes displayed an enhanced proinflammatory transcriptional state, whereas the transcriptional signature of Calr-Asxl1 co-mutant HSCs was indicative of inflammation-resistance. Genotyping of transcriptomes (GoT) confirmed an activated megakaryocytic differentiation program in CALR-ASXL1 co-mutant HSCs in primary human MPN bone marrow. These findings link the enhanced severity of CALR-ASXL1 co-mutant MPN to altered megakaryocyte differentiation and help explain some of the biological basis for the more severe MPN phenotype observed in patients.
    Keywords:  Hematology; Hematopoietic stem cells; Oncology
    DOI:  https://doi.org/10.1172/JCI201732
  2. Blood Neoplasia. 2026 Nov;3(4): 100290
      Variable risks of acute myeloid leukemia (AML) progression of myeloid malignancies are dependent upon their mutational and clinical features. A common TCL1A gene promoter polymorphism (rs2887399-T allele, G/T or T/T) reduces TCL1A expression and fitness for expansion of TCL1A-linked mutations recurrently found in MDS and CMML (TET2, ASXL1, SF3B1, SRSF2, IDH1/2, JAK2) compared to those with the G/G-allele (wild type). We analyzed 208 MDS and CMML patients who underwent targeted next generation sequencing of myeloid malignancy genes and rs2887399 genotyping. Primary analysis for evaluating AML-progression-free survival (PFS) and the cumulative incidence of AML progression compared patients with TCL1A-linked mutations plus the rs2887399-T allele to those with these mutations plus the wild type rs2887399-G/G genotype. Among patients with TCL1A-linked mutations (119/208, 57%), rs2887399-T carriers (n = 35) had lower 3-year AML progression (2.9% vs 18%, p = .037), longer AML PFS (96.4% vs 79.8%, P = .039) and lower cumulative incidence of AML (2.9% vs 17.3%, P = .006) than G/G carriers (n = 84), despite similar molecular risk. Multivariable Cox analysis showed reduced AML progression hazard in TCL1A-linked rs2887399-T carriers versus the TCL1A-linked-G/G and non-TCL1A-linked-T (HR 0.26, 95% CI 0.06-0.88, p=0.029). In conclusion, the rs2887399-T allele diminished and delayed AML evolution in MDS/CMML patients with TCL1A-linked mutations. These data support the concept that the TCL1A polymorphism in the setting of specific somatic mutations is a modulator of leukemogenesis, providing potential utility of such germline genotyping for disease risk stratification.
    DOI:  https://doi.org/10.1016/j.bneo.2026.100290
  3. Cell Rep. 2026 Oct 29. pii: S2211-1247(26)01305-7. [Epub ahead of print]45(11): 118226
      Proteins shuttle between the nucleus and cytoplasm through the nuclear pore and via nuclear transport receptors, termed importins and exportins. Although genetic alterations involving nucleoporins are enriched in pediatric, adolescent, and young adult (AYA) acute myeloid leukemia (AML), nucleocytoplasmic transport has not been extensively studied in this disease. We discover that genes encoding nucleocytoplasmic transport pathway components (Kyoto Encyclopedia of Genes and Genomes [KEGG]: hsa03013) are enriched in AML cells from younger patients (≤40 years). Within this pathway, CSE1L is the highest expressed exportin in pediatric/AYA AML and shows minimal expression in hematopoietic stem cells (HSCs). CSE1L depletion reduces leukemic cell growth, proliferation, and clonogenic capacity, targeting leukemia stem cells while sparing normal HSCs. Mechanistically, we identify a novel Ran-GTP-dependent role for CSE1L in regulating pre-60S ribosomal subunit export in AML. Collectively, these data identify nucleocytoplasmic transport and ribosomal subunit export as enriched dependencies in pediatric/AYA AML and establish CSE1L-mediated export as a leukemic vulnerability.
    Keywords:  CP: cancer; CSE1L; XPO2; acute myeloid leukemia; childhood AML; nuclear export; nucleocytoplasmic transport; pediatric AML; ribosomal subunit export; ribosome biogenesis
    DOI:  https://doi.org/10.1016/j.celrep.2026.118226
  4. Am J Hematol. 2026 Oct 26.
      The prognostic value of FLT3 internal tandem duplication (FLT3-ITD) in acute myeloid leukemia (AML) has traditionally been stratified according to the ITD/wild-type allelic ratio (AR) and NPM1 co-mutation status. We evaluated the prognostic impact of FLT3-ITD AR in 459 newly diagnosed AML patients younger than 60 years enrolled in the prospective BIG-1 study, all treated with high-dose anthracycline-based induction. From 2018 onward, midostaurin was added for FLT3-mutated cases. AR was not associated with composite complete remission (81.7% vs. 79.6% in low vs. high AR, p = 0.85), overall survival (OS) (median 7.6 vs. 6.9 years, p = 0.25), relapse-free survival (median 2.0 vs. 1.7 years, p = 0.50), or event-free survival (median 1.4 vs. 1.2 years, p = 0.58). In multivariable analyses, only midostaurin exposure (adjusted hazard ratio [aHR] 0.69, 95% CI 0.50-0.95, p = 0.024) and adverse ELN-2022 risk (aHR 1.66, 95% CI 1.18-2.34, p = 0.004) were independently associated with OS. Allogeneic hematopoietic stem cell transplantation was associated with improved relapse-free (aHR 0.40, 95% CI 0.29-0.55, p < 0.001) and event-free survival (aHR 0.37, 95% CI 0.27-0.51, p < 0.001), but not OS. These results indicate that FLT3-ITD AR has no independent prognostic impact in younger AML patients treated with intensive anthracycline-based chemotherapy and midostaurin in contemporary clinical practice.
    DOI:  https://doi.org/10.1002/ajh.70540
  5. Blood. 2026 Oct 26. pii: blood.2026035568. [Epub ahead of print]
      The discovery of recurrent somatic mutations affecting the RNA splicing machinery in 2011 revealed an unexpected class of driver mutations in hematologic malignancies. Remarkably, splicing factor (SF) mutations have emerged as some of the most frequent genetic lesions in myelodysplastic syndromes (MDS) and other dysplastic myeloid neoplasms, establishing aberrant RNA splicing as a major pathogenetic pathway in myeloid neoplasia. Subsequent studies have delineated their mutation-specific effects on RNA splicing and established their strong genotype-phenotype associations; consequently, SF mutations are now incorporated into contemporary disease classification and prognostic models. However, the mechanisms underlying their positive clonal selection and striking genotype-phenotype associations remain poorly understood, with co-mutations, clonal architecture, aging, and the hematopoietic microenvironment acting as important modifiers of disease expression. Elucidating how SF mutations interact with these modifiers to shape clonal fitness and disease phenotype remains a key challenge, while translating these biological insights into effective therapies represents the ultimate clinical goal.
    DOI:  https://doi.org/10.1182/blood.2026035568
  6. Ann Hematol. 2026 Aug 10. pii: 494. [Epub ahead of print]105(11):
      Core binding factor acute myeloid leukemia (CBF-AML)-defined by t(8;21) or inv(16) chromosomal rearrangements-is classified as favorable-risk disease per the European LeukemiaNet 2022 risk model and is typically treated with intensive chemotherapy. Patients unsuitable for intensive therapy increasingly receive hypomethylating agents plus venetoclax (HMA/ven), though CBF-AML was excluded from pivotal trials of this regimen. Furthermore, HMA/ven is typically administered as indefinite therapy in AML; however, there is increasing interest in exploring the feasibility of therapy cessation given persistent treatment-free remissions with this regimen. Here, we report the first case of sustained treatment-free remission following HMA/ven in CBF-AML. Features in this case that suggest a higher likelihood of achieving a durable treatment-free remission include inv(16) disease and rapid measurable residual disease (MRD) clearance. We summarize the current retrospective data comparing response rates of inv(16) vs. t(8;21) AML to HMA/ven: inv(16) AML consistently exhibits higher response rates compared with t(8;21) disease, although an overall survival benefit is not well established. Emerging data also suggest achieving MRD-negative complete remission after induction may predict more durable outcomes. This case provides proof-of-concept that carefully selected CBF-AML patients achieving sustained MRD-negative remission with HMA/ven can successfully discontinue therapy. Prospective evaluation of HMA/ven in unfit CBF-AML patients, weighed against dose-attenuated intensive chemotherapy, is needed to define its role and optimal duration.
    Keywords:  Core binding factor acute myeloid leukemia (CBF-AML); Hypomethylating agent; Treatment-free remission; Venetoclax
    DOI:  https://doi.org/10.1007/s00277-026-07237-0
  7. bioRxiv. 2026 Sep 03. pii: 2026.09.02.749005. [Epub ahead of print]
      STAG2 is the most frequently mutated cohesin gene in myeloid neoplasms, yet the significance of multiple mutations within this X-linked tumor suppressor remains unknown. We analyzed a cohort of 1,967 adult patients with myeloid neoplasms and identified 233 cases (12%) harboring STAG2 mutations, including 38 cases (16%) with multiple STAG2 hits. Patients with multi-hit STAG2 mutations exhibited increased multilineage dysplasia compared with single-hit cases and experienced inferior overall survival, an effect driven primarily by patients with myelodysplastic syndromes (MDS). To investigate the molecular basis of recurrent STAG2 acquisition, we performed long-read sequencing in representative cases with phaseable STAG2 mutations. In the informative case examined, distinct truncating STAG2 mutations did not co-occur on the same DNA molecule, supporting independent acquisition rather than stepwise allelic inactivation. Cohort-level variant allele frequency patterns were consistent with recurrent evolutionary targeting of STAG2 across related clonal populations. Together, these findings support a model in which multi-hit STAG2 mutations arise through convergent evolution and define a biologically distinct, adverse-risk subset of MDS.
    Keywords:  STAG2 multiple hits; clonal evolution; myeloid neoplasms; outcomes
    DOI:  https://doi.org/10.64898/2026.09.02.749005
  8. Haematologica. 2026 Oct 29.
      The QuANTUM-First trial (NCT02668653) showed quizartinib significantly improved overall survival (OS) versus placebo when added to standard chemotherapy and as maintenance monotherapy in patients with newly diagnosed, FMS-related tyrosine kinase 3-internal tandem duplication (FLT3-ITD)-positive acute myeloid leukemia. These post hoc analyses further evaluated clinical outcomes in older patients (≥60 years). Median OS was 17.5 and 14.2 months with quizartinib (n=107) and placebo (n=109), respectively (hazard ratio [HR], 0.91; 95% confidence interval [CI]: 0.66-1.26). Complete remission rates were similar (quizartinib, 53%; placebo, 55%), but median duration of complete response was numerically longer with quizartinib (15.9 vs. 9.0 months; HR, 0.92; 95% CI: 0.59-1.42). Cumulative incidence of relapse at 24 months was lower (quizartinib, 44%; placebo, 51%) and relapse-free survival was numerically longer (median, 16.6 vs. 9.7 months; HR, 0.91; 95% CI: 0.59-1.42) with quizartinib. NPM1 (quizartinib 62%, placebo 61%) and DNMT3A (51% and 50%) mutations were common and often co-mutated together (NPM1+DNMT3A; 38% and 38%), with each mutation or combination associated with numerically longer median OS with quizartinib (vs. placebo): 25.8 versus 15.4 (NPM1), 15.6 versus 11.5 (DNMT3A), and 21.8 versus 9.7 months (NPM1+DNMT3A), respectively. Quizartinib showed manageable tolerability for older patients, with safety generally similar to the placebo arm. Higher frequency of gastrointestinal treatmentemergent adverse events and a longer time to hematologic recovery were observed with quizartinib. ClinicalTrials.gov Identifier: NCT02668653.
    DOI:  https://doi.org/10.3324/haematol.2026.301241
  9. Leukemia. 2026 Oct 28.
      The hyperactive kinase FLT3-ITD causes acute myeloid leukemia (AML) and is a prognostic biomarker. We synthesized and characterized MA191 as a novel von Hippel-Lindau (VHL) E3 ubiquitin ligase-based proteolysis targeting chimera (PROTAC) for FLT3. MA191 induces apoptosis in cultured and primary AML patient cells harboring FLT3-ITD (IC50=9.6-11 nM; EC50=0.001-0.883 µM). Comparison with a VHL-binding-deficient stereoisomer of MA191 demonstrates that FLT3-ITD degradation is superior to kinase inhibition (p < 0.03). Rapid depletion of FLT3-ITD by MA191 (DC50=10 nM) requires VHL, neddylation, proteasome activity, and the pro-apoptotic BH3-only protein BIM. MA191 reduces FLT3-ITD prior to apoptosis, uncovering apoptosis-independent roles of BIM for protein stability. Higher expression levels of FLT3 in leukemia cells than in healthy cells (n = 3675/n = 1249) are associated with worse AML patient survival (p = 0.0099). MA191 does not harm healthy blood and bone marrow progenitor cells or myeloid cell differentiation. In Danio rerio larvae, MA191 halts AML cell proliferation without significant toxicity. Human stromal cell interactions and mutations in the tyrosine kinase domain of FLT3-ITD that confer resistance to FLT3 inhibitors do not abolish anti-leukemic effects of MA191. Accordingly, leukemia cells with acquired resistance to MA191 lack such mutations. We offer a framework for fast-acting next-generation FLT3 degraders that overcome resistance mechanisms to classical inhibitors.
    DOI:  https://doi.org/10.1038/s41375-026-03168-x
  10. bioRxiv. 2026 Oct 08. pii: 2026.10.01.756000. [Epub ahead of print]
      CBFA2T3-GLIS2 (C/G) defines a high-risk pediatric AML subtype in which de novo enhancer rewiring sustains an aggressive leukemic transcriptional state. The early epigenomic mechanisms reinforcing this program and linking it to leukemic survival remain incompletely defined. Here, we identify enhancer-proximal hypermethylation as a noncanonical, transcription-permissive feature of C/G AML. Using primary C/G-positive AML samples and a developmentally relevant C/G-transformed cord blood hematopoietic stem/progenitor cell model, we integrated DNA methylation, chromatin state, fusion occupancy, and gene expression across early and leukemia-stage contexts. Early C/G-associated hypermethylated regions localized near H3K27ac/H3K4me1-marked active or primed cis-regulatory elements, were enriched for ERG/ETS-like motifs, and showed related architecture in leukemia-stage contexts. DNMT3B was prominently increased in C/G contexts, and its loss selectively altered methylation-associated gene expression without measurably changing global 5mC. Genetic DNMT3B loss increased venetoclax sensitivity in vitro, while pharmacologic DNMT3B inhibition with Nanaomycin-A similarly enhanced venetoclax response. During venetoclax treatment, DNMT3B-deficient xenografts showed reduced disease burden and prolonged survival. To assess whether this interaction extended to clinically used hypomethylating agents, azacitidine or decitabine plus venetoclax induced apoptosis-related transcriptional programs and mitochondrial depolarization. These findings identify hypermethylated active cis-regulatory elements as C/G-associated states linked to transcriptional dysregulation and venetoclax response.
    DOI:  https://doi.org/10.64898/2026.10.01.756000
  11. Exp Hematol. 2026 Oct 24. pii: S0301-472X(26)00588-6. [Epub ahead of print] 105955
      Pediatric acute myeloid leukemia (AML) frequently involves chromosomal rearrangements, particularly KMT2A (MLL) gene fusions, with the KMT2A-MLLT4 (KM4-AML) fusion being highly aggressive and associated with poor prognosis. This study presents a comparative analysis of transcriptomic and epigenetic profiles between human leukemia models harboring KM4-AML and KMT2A-MLLT3 (KM3-AML) fusions. Transcriptomic signatures of KM4-AML models closely resembled those of patient samples, underscoring the model's clinical relevance. Epigenetic analysis revealed distinct chromatin accessibility and methylation patterns between KM4-AML and KM3-AML, particularly in enhancer regions linked to aggressive leukemia phenotypes. PROM1 was identified as a potential biomarker for KM4-AML, with its overexpression correlating with poor prognosis. Furthermore, high-throughput drug screening identified dopamine receptor antagonists (DRAs) as promising therapeutic candidates showing selective response for KM4-AML models. Docking simulations and NMR assays confirmed favorable binding interactions between DRAs and S100A8, S100A9 and ANXA6. These findings provide insights into the molecular mechanisms driving KM4-AML and offer potential therapeutic avenues for treatment.
    Keywords:  KMT2A-AML; KMT2A-MLLT4; NMR; drug screen; selectivity drug activity
    DOI:  https://doi.org/10.1016/j.exphem.2026.105955
  12. Nature. 2026 Oct 28.
      The N7-methylguanosine (m7G) modification is one of the most prevalent tRNA modifications, mainly catalysed by the METTL1-WDR4 protein complex1-4. The m7G methyltransferase METTL1 has been linked to oncogenic transformation and the maintenance of several aggressive malignancies; however, the clinical implications of therapeutically targeting a tRNA-modifying enzyme have not been established. Here we present the development and characterization of STM9005, a highly selective and potent first-in-class tRNA methyltransferase inhibitor of METTL1. Treatment of numerous cancer cell models (including leukaemia, melanoma, pancreatic carcinoma, oesophageal cancer and small cell lung carcinoma) with STM9005 blocks cell growth, causes differentiation changes and dysregulates cell cycle progression. These cellular effects were accompanied by a selective decrease in m7G on a subset of tRNAs and a reduction in their expression levels, which impacted the translation of oncogenic mRNAs. We show that pharmacological inhibition of METTL1 in vivo impairs tumour growth and significantly prolongs survival in multiple mouse cancer models of different tissue origin. Collectively, our results provide a strong proof of concept that targeting of tRNA methylation is a promising avenue of anti-cancer therapy and illustrate that catalytic inhibition of METTL1 represents a therapeutic strategy against a number of aggressive malignancies.
    DOI:  https://doi.org/10.1038/s41586-026-11178-z
  13. Haematologica. 2026 Oct 29.
      Our understanding of essential thrombocythemia (ET) and polycythemia vera (PV) in children and adolescents is limited to retrospective analyses partly including young adults. Here, we present the largest set of prospectively acquired clinical and genetic data of pediatric patients up to the age of 18 years at diagnosis of ET and PV from the German myeloproliferative neoplasms (MPN) Childhood Registry. Forty-five patients were diagnosed with ET (n=39; 87%) or PV (n=6; 13%). Thirty-one cases (69%) had at least one established clinical adverse prognostic marker at diagnosis represented by symptoms of hyperviscosity/microcirculatory disturbance and/or splenomegaly in 22 patients (49%) each. Twenty patients (44%) carried JAK2V617F (ET n=14; PV n=6), one patient (2%) showed a non-V617F JAK2 variant of uncertain significance, eight (18%) had a pathogenic CALR variant (Type I/II), and 14 (31%) did not show a known somatic (likely) pathogenic driver variant in the classical gene regions of JAK2, CALR, or MPL. No additional cooperating non-driver variants commonly observed in adult patients with MPN were detected using targeted sequencing. However, we identified likely pathogenic germline variants in five patients without a known somatic driver variant: JAK2:c.2624C>A p.(Thr875Asn), JAK2:c.2047A>G p.(Arg683Gly), THPO:c.13+1G>A r.spl p.?, FLT3:c.2525A>G p.(Tyr842Cys), and SAMHD1:c.500A>C p.(His167Pro). Neither the high prevalence of clinical risk features nor the observed enrichment of germline variants identified through targeted sequencing have been previously described in the context of pediatric MPN. This study confirms that pediatric MPN carries a substantial early disease burden and identified potential predisposing variants with possible implications for cancer surveillance and therapy.
    DOI:  https://doi.org/10.3324/haematol.2026.301474
  14. Cell Stem Cell. 2026 Oct 28. pii: S1934-5909(26)00380-2. [Epub ahead of print]
      Cell surface expression of the Slam family member CD150 is widely used for the prospective isolation of multipotent long-term hematopoietic stem cells (LT-HSCs). Here, we identify a bona fide endothelial protein C receptor (EPCR)+CD150- HSC subset, termed LT-HSC2, that sustains serial multi-lineage reconstitution. Long-term label-retaining assays reveal that LT-HSC2s are more deeply dormant than conventional EPCR+CD150+ LT-HSC1s, exhibit reduced cell cycle activation in response to inflammatory stress, and preserve stemness for prolonged periods in vivo. Moreover, combining EPCR with established HSC and multipotent progenitor (MPP) markers resolves the earliest stages of lineage divergence toward megakaryocytic/erythroid-biased CD150+ and lymphoid-biased CD150- trajectories. Thus, EPCR expression in HSCs and MPPs is associated with increased stemness, whereas CD150 expression does not encompass the full spectrum of long-term repopulating HSCs. Our findings establish EPCR+CD150- LT-HSC2s as a distinct, exceptionally dormant stem-cell subset and reveal an additional layer of HSC heterogeneity governing self-renewal, decreased stress sensitvity. and earliest lineage priming.
    Keywords:  CD150; LT-HSC; SLAM marker; dormancy; endothelial protein C receptor; epigenetic priming; hematopoietic stem cell; lineage differentiation; multipotent progenitor 6; self-renewal
    DOI:  https://doi.org/10.1016/j.stem.2026.09.016
  15. Blood Adv. 2026 Oct 30. pii: bloodadvances.2026020561. [Epub ahead of print]
      Acute myeloid leukemia (AML) is a clinically aggressive malignancy with poor outcomes driven by frequent relapse and therapeutic resistance. Because the SUMOylation pathway regulates genome maintenance, transcription control, and immune evasion, it represents a promising therapeutic target in AML. We evaluated the therapeutic and immunomodulatory effects of TAK-981 using patient-derived AML samples and preclinical models. Expression of SUMO pathway components (SAE1, SAE2, and UBC9) was assessed in newly diagnosed AML and correlated with bone marrow blast burden. Anti-leukemic activity and drug interactions with venetoclax and gilteritinib were tested in vitro and ex vivo and validated in xenograft models, while immune reprogramming was characterized in immunocompetent AML models by profiling immune subsets and effector cytokine/mediator signatures. SAE1, SAE2, and UBC9 were significantly higher in bulk diagnostic specimens than in remission specimens and positively correlated with blast percentages. TAK-981 showed potent anti-leukemic activity and synergized with venetoclax and gilteritinib in vitro and ex vivo. In xenograft studies, TAK-981 enhanced the efficacy of both agents, and a four-week triplet regimen produced durable disease control and superior survival benefit with a favorable safety profile. In immunocompetent models, TAK-981 induced systemic immune remodeling, including increased CD8⁺ T-cell and NK-cell frequencies, memory T-cell polarization, and sustained elevation of granzyme B, IFN-γ, and TNF-α. These findings support SUMO pathway inhibition with TAK-981 as a promising combinatorial strategy to improve treatment durability and overcome resistance in AML through both direct anti-leukemic effects and immune reprogramming.
    DOI:  https://doi.org/10.1182/bloodadvances.2026020561
  16. Blood. 2026 Oct 26. pii: blood.2026035181. [Epub ahead of print]
      Donor cell-derived hematologic neoplasm (DDHN) is defined as a de novo hematologic malignancy originated from transplanted donor stem cells, distinct from the original recipient's disease (ORD). Its prevalence and biological mechanisms remain poorly defined. We conducted a nationwide study to estimate the prevalence of DDHN and characterize its clinical and molecular features. Twenty-four transplantation centers systematically reviewed their allogeneic hematopoietic stem cell transplantation (allo-HSCT) cohorts. DDHN diagnosis required cytogenetic or molecular donor-origin confirmation. Molecular studies included germline-augmented targeted NGS, whole-exome sequencing, and donor-recipient comparative analyses. We identified 39 DDHN cases diagnosed between 2007 and 2025. Among 8,465 allo-HSCT performed between 2013-2022, DDHN prevalence was 0.28%, with a marked predominance after related-donor compared with unrelated transplantation (0.41% vs. 0.06%, p=0.0026). Median latency from transplantation to DDHN diagnosis was 56 months. Most DDHN were myeloid neoplasms, predominantly myelodysplastic neoplasms (51%) and acute myeloid leukemia (36%). Molecular characterization, available in 33 cases, revealed germline predisposition as the predominant underlying mechanism. Pathogenic/likely pathogenic germline variants were identified in 10 cases, involving DDX41 (n=7), CEBPA (n=2), and CHEK2 (n=1), all after a related-donor transplantation. DDX41-associated DDHN showed recurrent somatic hits and low genomic complexity. Donor-derived clonal hematopoiesis was confirmed in only one myeloid case involving U2AF1. These findings support inherited germline predisposition as the potential main molecular driver of DDHN after related allo-HSCT, reinforcing the recommendation for comprehensive germline evaluation of patients at ORD diagnosis prior to transplantation, followed by targeted cascade screening of candidate related donors.
    DOI:  https://doi.org/10.1182/blood.2026035181
  17. Blood. 2026 Oct 28. pii: blood.2026034684. [Epub ahead of print]
      Distinguishing inherited bone marrow failure syndromes (IBMFS) from acquired idiopathic severe aplastic anemia (SAA) impacts treatment decisions and long-term management. The diagnostic evaluation of SAA has evolved with advances in our understanding of IBMFS. The benefit of germline genetic testing to screen for IBMFS in the context of current comprehensive SAA evaluations has not been systematically assessed. Awaiting genetic testing can delay treatment for idiopathic SAA increasing the risk of life-threatening complications. This retrospective study investigates the incidence of cryptic IBMFS among pediatric patients with SAA evaluated with current standard-of-care clinical and laboratory assessments. Enhanced whole exome sequencing tailored to IBMFS genes was conducted for 153 patients with SAA. Comprehensive clinical and laboratory diagnostic data were available for 149 patients. No clinical or laboratory features of an IBMFS were identified in 113 patients (75.8%) and none harbored pathogenic or likely pathogenic variants diagnostic of IBMFS. At least one clinical finding suggestive of an IBMFS was identified in the remaining 36 patients (24.2%). Of these, one harbored a heterozygous pathogenic variant in SAMD9L and had a consistent clinical history. A second patient flagged by clinical evaluation had two pathogenic variants in ERCC6L2, although allelic phasing and therefore affected status could not be determined. For patients with a negative comprehensive workup for SAA utilizing current diagnostic clinical and laboratory evaluations, the risk of a cryptic IBMFS is low. For these patients, the low likelihood of benefit gained by awaiting genetic testing results must be weighed against the risks of treatment delay.
    DOI:  https://doi.org/10.1182/blood.2026034684
  18. Nat Commun. 2026 09 28. pii: 11175. [Epub ahead of print]17(1):
      ClpP protease maintains proteostasis in human mitochondria and is overexpressed in cancers such as acute myeloid leukemia (AML). While activators such as dordaviprone (ONC201) have reached the clinic, the development of ClpP inhibitors has been hampered by paradoxical activation upon orthosteric inhibitor binding. Here, we report a series of quinazolinone-based compounds that allosterically inhibit human ClpP with nanomolar potency. Cryo-EM and H/D exchange mass spectrometry reveal that our lead compound binds sub-stoichiometrically to a distal hydrophobic pocket ~30 Å from the active sites, disrupts a conserved inter-subunit cluster, and induces a conformational change that misaligns the catalytic triad, thereby inactivating ClpP. The binding site of our quinazolinone-based inhibitors partially overlaps with that of the activator dordaviprone. In a xenograft mouse model of leukemia, our lead compound significantly reduced tumor burden following short-term oral administration. Our findings identify a regulatory hotspot in human ClpP and a mechanistically distinct inhibition strategy.
    DOI:  https://doi.org/10.1038/s41467-026-78140-5
  19. bioRxiv. 2026 Oct 10. pii: 2026.10.01.755757. [Epub ahead of print]
      The mammalian BRG-/BRM-associated factor (BAF) chromatin remodeling complexes are crucial regulators of hematopoietic stem and progenitor cell (HSPC) fate. Expression of the ncBAF subcomponent, BRD9, is altered in both normal aging and myeloid malignancies. We find that in adult human HSPC, BRD9 regulates the differentiation of myeloid progenitors. Upon degradation of BRD9 in these cells, ncBAF is displaced from the chromatin, leading in turn to enhanced recruitment of cBAF to bona fide CEBPA target sites. With the shift from ncBAF to cBAF, HSPC differentiation results in increased generation of myeloid-derived suppressor cells (MDSC) that secrete elevated levels of IL-8. Soluble factors from these myeloid cells, which have lost BRD9, enhance the stemness of breast cancer cells in vitro. In contrast, bromodomain inhibition of BRD9 results in minimal alterations of ncBAF binding and myeloid differentiation, indicating that BRD9 acts as a barrier to human MDSC differentiation in a bromodomain-independent manner.
    KEY POINTS: BRD9 suppresses the development of myeloid-derived suppressor cells in a bromodomain-independent mannerLoss of BRD9 results in increased cBAF recruitment to CEBPA target sites and enhanced myeloid differentiation.
    DOI:  https://doi.org/10.64898/2026.10.01.755757
  20. bioRxiv. 2026 Sep 04. pii: 2026.09.01.748392. [Epub ahead of print]
      Obesity expands myeloid progenitors, myelopoiesis and increases the production of monocytes. While weight loss (WL) alleviates aspects of this inflammatory dysregulation, it is not known whether GLP-1 receptor agonists or other traditional modalities of WL differentially modify hematopoietic stem/progenitor cells (HSPCs), hematopoiesis, or inflammatory cell production. To test this, we compared the hematopoietic compartment in lean, obese and weight-reduced mice from tirzepatide treatment and caloric restriction (CR) implemented to match the body weight in both groups. At equal WL, we found CR induced multilineage cytopenias, whereas tirzepatide preserved blood lineages while specifically reducing classical Ly6Chi CCR2+ monocytes. To define the mechanisms underlying these changes we performed single-cell mRNA sequencing of bone marrow HSPCs and mature mononuclear blood cells. CR-HSPCs suppressed gene sets associated with nutrient sensing, proliferation and oxidative phosphorylation (OXPHOS) and exhibited lower inferred cell cycle activity, whereas tirzepatide-HSPCs attenuated these changes. Unlike CR, we found that across progressively differentiated cells from HSPCs to mature blood monocytes, tirzepatide increasingly suppressed OXPHOS and simultaneously shifted the maturation spectrum away from classical monocytes. Following six weeks of tirzepatide withdrawal and weight regain, Ly6Chi CCR2+ monocytes rebounded to levels seen in obese mice. These findings suggest that tirzepatide uncouples WL from the broad hematopoietic suppression seen in CR by preserving progenitor activity but selectively remodeling inflammatory/classical monocytes. We demonstrate that WL modality differentially impacts hematopoietic adaptation and provide evidence that classical monocytes are an effector cell through which tirzepatide may dampen obesity-associated inflammation.
    DOI:  https://doi.org/10.64898/2026.09.01.748392
  21. Exp Hematol. 2026 Oct 27. pii: S0301-472X(26)00593-X. [Epub ahead of print] 105960
      Inflammasomes are multiprotein complexes that sense pathogen- and damage-associated molecular patterns and induce inflammatory responses and have been implicated in the pathogenesis of myelodysplastic syndrome (MDS). However, their functional contribution to MDS progression in vivo have not yet been elucidated. Here, we investigated the effects of inflammasome inhibition in mouse models of MDS by deleting Asc, an adaptor protein that links inflammasome sensor proteins to caspase-1. Asc-deficient mice showed no significant hematopoietic defects under steady-state conditions or in competitive bone marrow reconstitution assays. In an MDS mouse model co-expressing CBLΔE8/9 and RUNX1S291fs, mice developed MDS and eventually progressed to acute myeloid leukemia regardless of Asc status. However, compared with wild-type MDS mice, which progressed to lethal MDS, Asc-deficient MDS mice exhibited attenuated caspase-1 activation, delayed MDS progression, and significantly prolonged survival. Asc deficiency also substantially attenuated the MDS phenotypes induced by Tet2 deficiency. Levels of IL-1β and/or IL-18, key inflammatory cytokines produced downstream of inflammasome activation, were elevated in the bone marrow fluid of these MDS models and reduced by Asc deficiency. These findings demonstrate that ASC-dependent inflammasome signaling contributes to MDS progression in vivo and suggest that targeting inflammasome signaling may represent a potential therapeutic approach for MDS. Teaser Abstract We investigated the effects of inflammasome inhibition in mouse models of MDS by deleting Asc, an adaptor protein that links inflammasome sensor proteins to caspase-1. In an MDS mouse model, mice developed MDS and eventually progressed to acute myeloid leukemia regardless of Asc status. However, compared with wild-type MDS mice, which progressed to lethal MDS, Asc-deficient MDS mice exhibited attenuated caspase-1 activation, delayed MDS progression, and significantly prolonged survival. Asc deficiency also substantially attenuated the MDS phenotypes induced by Tet2 deficiency. These findings demonstrate that ASC-dependent inflammasome signaling contributes to MDS progression in vivo.
    Keywords:  ASC; Inflammasome; myelodysplastic syndrome
    DOI:  https://doi.org/10.1016/j.exphem.2026.105960
  22. bioRxiv. 2026 Sep 02. pii: 2026.09.01.747091. [Epub ahead of print]
      Aged hematopoietic stem cells (HSCs) exhibit a shift from balanced to myeloid-biased differentiation, resulting in reduced lymphoid output and impaired adaptive immunity. The question of whether this lineage bias is established in a subset of HSCs during early development or primarily emerges with aging warrants further investigation. Here, we investigate whether myeloid-biased HSCs (my-HSCs) are established at the fetal liver stage by specifically examining Neogenin-1 (NEO1), a previously defined marker of my-HSCs. We identify two distinct populations of Hoxb5 + HSCs in the fetal liver: NEO1 + and NEO1, with NEO1 + HSCs exhibiting transcriptional and functional characteristics consistent with my- HSCs. With age, my-HSC-associated transcriptional programs become increasingly reinforced across the Hoxb5 + pHSC compartment, with NEO1 + cells showing early enrichment of this program and both NEO1 + and NEO1 - cells acquiring broader myeloid-biased features in aging. These findings suggest that lineage programming can begin early in development and is further shaped by age-related changes, potentially contributing to the functional decline observed in the aging hematopoietic system.
    DOI:  https://doi.org/10.64898/2026.09.01.747091
  23. Nat Metab. 2026 Oct 27.
      Mutations in mitochondrial DNA (mtDNA) impair ETC activity and oxidative phosphorylation, but their phenotypic consequences vary with heteroplasmy levels. Whether increasing mtDNA heteroplasmy creates metabolic dependencies not present in respiratory-competent cells remains unknown. Here, we show that low pyruvate carboxylase (PC) expression creates an asparagine dependency in high-mtDNA-heteroplasmy, respiration-compromised cells. In isogenic cells carrying similar mtDNA deletions, respiration declines linearly with increasing heteroplasmy, whereas redox imbalance emerges only above 50% heteroplasmy. Above 70% heteroplasmy, integrated stress-response-associated translational defects emerge, which can be reversed by either exogenous asparagine or PC overexpression. Asparagine dependence inversely correlates with PC expression across respiration-deficient cells. Consistent with this pattern, patient-derived thyroid tumour cells harbouring a high-heteroplasmy complex I mutation and low PC levels exhibit asparagine auxotrophy and sensitivity to L-asparaginase. Together, these findings demonstrate a role for mitochondrial PC in cellular asparagine synthesis under conditions of compromised respiratory activity.
    DOI:  https://doi.org/10.1038/s42255-026-01651-4