BH3 profiling as a tool to identify acquired resistance to venetoclax in multiple myeloma.

Abstract

BH3 profiling as a tool to identify acquired resistance to venetoclax in multiple myeloma Venetoclax/ABT-199 is the first in the class of BCL2-specific BH3 mimetics and the most promising targeted therapy in oncology (Souers et al, 2013). Venetoclax is currently under investigation in multiple myeloma (MM), which is heterogeneous and includes either patients with a translocation on chromosome 14 with different chromosomes (4, 6, 11 or 16) or a hyperdiploidy. We demonstrated that venetoclax induces cell death in a subgroup harbouring the t(11;14) transloca-tion, expressing a high BCL2/MCL1 gene expression ratio, and that intrinsic venetoclax resistance is mediated by high MCL1 expression in MM cells (Touzeau et al, 2014). Preliminary results from an ongoing phase I clinical trial testing venetoclax in relapsed/refractory MM patients indicate that BCL2 inhibition has a tolerable safety profile and single agent activity mostly in t(11;14) patients (Kumar et al, 2015). The anticipated use of venetoclax in the treatment of MM lead us to explore the mechanisms of acquired veneto-clax resistance. We generated two venetoclax-resistant mye-loma cell lines using in vitro selection and derived resistant sublines (named-199R) from KMS12-PE and XG5 t(11;14) myeloma venetoclax-sensitive cell lines (Figs 1A, 2A) (Data S1). Both resistant sublines showed a strong reduction in V