Priority Research Papers:

Synergistic effects of p53 activation via MDM2 inhibition in combination with inhibition of Bcl-2 or Bcr-Abl in CD34+ proliferating and quiescent chronic myeloid leukemia blast crisis cells

Bing Z. Carter _, Po Yee Mak, Duncan H. Mak, Vivian R. Ruvolo, Wendy Schober, Teresa McQueen, Jorge Cortes, Hagop M. Kantarjian, Richard E. Champlin, Marina Konopleva and Michael Andreeff

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Oncotarget. 2015; 6:30487-30499. https://doi.org/10.18632/oncotarget.5890

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Bing Z. Carter1, Po Yee Mak1, Duncan H. Mak1, Vivian R. Ruvolo1, Wendy Schober1, Teresa McQueen1, Jorge Cortes2, Hagop M. Kantarjian2, Richard E. Champlin3, Marina Konopleva1 and Michael Andreeff1

1 Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

2 Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

3 Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

Correspondence to:

Bing Z. Carter, email:

Michael Andreeff, email:

Keywords: blast crisis CML, quiescent CD34+ cells, Nutlin3a, TKI, Bcl-2

Received: June 11, 2015 Accepted: September 04, 2015 Published: September 29, 2015


The Bcr-Abl tyrosine kinase regulates several Bcl-2 family proteins that confer resistance to apoptosis in chronic myeloid leukemia (CML) cells. Given p53’s ability to modulate the expression and activity of Bcl-2 family members, we hypothesized that targeting Bcr-Abl, Bcl-2, and p53 concomitantly could have therapeutic benefits in blast crisis (BC) CML and in quiescent CML CD34+ cells that are insensitive to tyrosine kinase inhibitors (TKI). We examined the effects of the MDM2 inhibitor nutlin3a and its combination with the dual Bcl-2 and Bcl-xL inhibitor ABT-737, and the Bcr-Abl inhibitor nilotinib on BC CML patient samples. We found that in quiescent CD34+ progenitors, p53 expression is significantly lower, and MDM2 is higher, compared to their proliferating counterparts. Treatment with nutlin3a induced apoptosis in bulk and CD34+CD38- cells, and in both proliferating and quiescent CD34+ progenitor CML cells. Nutlin3a synergized with ABT-737 and nilotinib, in part by inducing pro-apoptotic, and suppressing anti-apoptotic, Bcl-2 proteins. Nilotinib inhibited the expression of Bcl-xL and Mcl-1 in BC CML cells. These results demonstrate that p53 activation by MDM2 blockade can sensitize BC CML cells, including quiescent CD34+ cells, to Bcl-2 inhibitor- and TKI-induced apoptosis. This novel strategy could be useful in the therapy of BC CML.

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