Determinants of venetoclax resistance

The study aimed to identify genetic determinants of resistance to Venetoclax, a recently approved BCL-2 inhibitor for patients with chronic lymphocytic leukemia (CLL). Whole exome sequencing of tumor samples from 6 CLL patients relapsing on Venetoclax revealed clonal evolution when comparing pre- and post-Venetoclax samples. Genetic screens for genes involved in sensitivity to Venetoclax and investigations of resistant cell lines (including OCI-Ly1) revealed MCL-1 and regulators of cellular energy metabolism (AMPK pathway) to drive resistance to Venetoclax. Further explorations of patient samples confirmed MCL-1 expression and AMPK activation to be increased at relapse on Venetoclax.