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ERADICATING MINIMAL RESIDUAL DISEASE IN AML

While AML often responds well to initial treatment, many patients have residual cancer cells that may cause the disease to return. Too frequently, the resurgent neoplasm does not respond to follow-up treatments — perhaps because of residual cells’ inherent resistance, or due to a protective niche in the micro-environment or resulting from as-yet-unknown factors. This ambitious project explores the biological mechanisms underlying residual AML, seeking to identify targets for treatment strategies to keep the disease from returning.

While AML often responds well to initial treatment, many patients have residual cancer cells that may cause the disease to return. Too frequently, the resurgent neoplasm does not respond to follow-up treatments — perhaps because of residual cells’ inherent resistance, or due to a protective niche in the micro-environment or resulting from as-yet-unknown factors. This ambitious project explores the biological mechanisms underlying residual AML, seeking to identify targets for treatment strategies to keep the disease from returning.

PROJECT HIGHLIGHTS

  • Aiming to identify the mechanisms underlying persistent residual disease in AML, especially its ability to evade chemotherapy and the immune system.
  • Developing novel clinical-grade assays and tools for detecting and quantifying residual AML.
  • Identifying cell and micro-environmental adaptations that facilitate residual AML cells’ survival.
  • Testing novel clinical strategies that target vulnerabilities in residual AML cells.

MEET THE TEAM

The researchers who comprise the Eradicating Measurable Residual Disease TeamLab are at the forefront of AML basic, translational, and clinical science taking place at five leading institutions. The project will enable them to leverage and combine the multidisciplinary expertise and resources by working collaboratively across institutions. They will, for example, be able to share patient samples and laboratory reagents, perform multi-site clinical trials, and cross-validate their unique quantitation and characterization platforms. The potential impact will greatly exceed the sum of the parts.
We invite you to learn about the institutions and individual investigators driving this important scientific and clinical research project.

AllDana-Farber Cancer InstituteMemorial Sloan Kettering Cancer CenterMIT’s Koch Institute for Integrative Cancer ResearchThe Sidney Kimmel Comprehensive Cancer Center at Johns HopkinsThe University of Texas MD Anderson Cancer CenterAlbert Einstein College of Medicine

MEET THE TEAM

The researchers who comprise the Eradicating Measurable Residual Disease TeamLab are at the forefront of AML basic, translational, and clinical science taking place at five leading institutions. The project will enable them to leverage and combine the multidisciplinary expertise and resources by working collaboratively across institutions. They will, for example, be able to share patient samples and laboratory reagents, perform multi-site clinical trials, and cross-validate their unique quantitation and characterization platforms. The potential impact will greatly exceed the sum of the parts.
We invite you to learn about the institutions and individual investigators driving this important scientific and clinical research project.

View Team
AllDana-Farber Cancer InstituteMemorial Sloan Kettering Cancer CenterMIT’s Koch Institute for Integrative Cancer ResearchThe Sidney Kimmel Comprehensive Cancer Center at Johns HopkinsThe University of Texas MD Anderson Cancer CenterAlbert Einstein College of Medicine

PROJECT SUMMARY

The value of treating residual disease is well-established with acute lymphoblastic leukemia (ALL), where treatments have proven to eradicate residual cancer cells and enhance patient outcomes. However, because AML is more genetically heterogeneous — meaning that each patients’ disease may be unique — measuring the extent of minimal residual disease and finding effective treatments for such residual AML has been much more challenging. As a result, many clinicians currently view residual disease in AML as a phenomenon, not necessarily as a target for novel therapies.
This project applies cutting-edge molecular and cell biology techniques to redefine and recast the view of residual disease in AML: The project’s research team intends to develop a more complete understanding of the biology of persistent residual disease and of its ability to evade chemotherapy and immune clearance. That new scientific knowledge will then be used to develop novel therapeutic agents and combinations; and, simultaneously, the researchers will establish a clinical framework for innovative clinical trials of promising new treatments targeting these newly revealed vulnerabilities in residual AML cells.
Toward those goals, the Eradicating Residual Disease in AML TeamLab is pursuing three specific research aims.

The first aim is to develop novel clinical-grade assays to detect and quantify residual AML.
Utilizing state-of-the-art techniques, researchers will work to establish the gold standard assay — or combination of assays — for detecting and monitoring the residual disease. These will include highly sensitive molecular, single cell DNA, and immune-phenotypic technologies for evaluating patient samples collected at diagnosis, remission, and during clinical trials.
The second aim is to test novel clinical strategies targeting residual AML. The researchers will use a multi-site clinical trial platform to test the hypothesis that targeting vulnerabilities associated with three specific leukemia genotypes will eradicate residual disease and prevent relapse. Samples from patients enrolled in these trials will also be used to prospectively evaluate the novel detection tools developed for the first aim and to pursue the third aim.
The third aim is to identify cellular and environmental adaptations that facilitate the persistence and survival of residual AML cells. In particular, the researchers will test the hypothesis that the biology of residual AML is distinct from bulk leukemic disease. They will compare pre-treatment AML cells with samples of residual AML and relapsed AML in patients — as well as from genetically engineered mouse models. These will be investigated using novel single cell genomic, proteomic, and biophysical methods, and through studies of AML micro-environment and immunology. Integrating these results with functional genomic approaches to identify residual AML cell vulnerabilities, the team will then develop novel therapeutic approaches.
Collectively, the work toward these aims will help answer fundamental and important questions about residual disease in AML such as: How should it be quantified and what is actually being measured? Is AML relapse simply a “numbers game” or is the biology of residual disease distinct? And will targeting the unique biology of residual AML with rationally selected therapy cure AML?
By pursuing answers to these questions in a synergistic fashion, the TeamLab hopes to generate a flexible, multi-disciplinary platform for rich scientific discovery and rapid clinical translation and implementation.

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