Extracellular matrix stiffness influences biological functions of some tumors. However, it remains unclear how cancer subtypes with different oncogenic mutations respond to matrix stiffness. In addition, the relevance of matrix stiffness to in vivo tumor growth kinetics and drug efficacy remains elusive. Here, we designed 3D hydrogels with physical parameters relevant to hematopoietic tissues and adapted them to a quantitative high-throughput screening format to facilitate mechanistic investigations into the role of matrix stiffness on myeloid leukemias. Matrix stiffness regulates proliferation of some acute myeloid leukemia types, including MLL-AF9 + MOLM-14 cells, in a biphasic manner by autocrine regulation, whereas it decreases that of chronic myeloid leukemia BCR-ABL + K-562 cells.Although Arg-Gly-Asp (RGD) integrin ligand and matrix softening confer resistance to a number of drugs, cells become sensitive to drugs against protein kinase B (PKB or AKT) and rapidly accelerated fibrosarcoma (RAF) proteins regardless of matrix stiffness when MLL-AF9 and BCR-ABL are overexpressed in K-562 and MOLM-14 cells, respectively. By adapting the same hydrogels to a xenograft model of extramedullary leukemias, we confirm the pathological relevance of matrix stiffness in growth kinetics and drug sensitivity against standard chemotherapy in vivo. The results thus demonstrate the importance of incorporating 3D mechanical cues into screening for anticancer drugs.matrix stiffness | systems pharmacology | biomaterials | drug screening | cancer M yeloid leukemias originate from the hematopoietic stem cell compartment in bone marrow (BM) after oncogenic mutations. For instance, a translocation between parts of the human chromosome 22 and 9 results in the BCR-ABL fusion gene that causes chronic myeloid leukemia (CML) (1). Some translocations involving the mixed lineage leukemia (MLL) gene in the human chromosome 11, band q23, such as the MLL-AF9 fusion gene, are involved in acute myeloid leukemia (AML) (2). In addition to mutations, hematopoietic microenvironments can contribute to pathogenesis and progression of myeloid leukemias (3). Both oncoproteins and cell-extrinsic factors are known to perturb various signaling pathways that regulate key biological processes in cancer. For instance, AKT/PKB (protein kinase B) is a major signaling node downstream of activated tyrosine kinases and phosphatidylinositol 3-kinase and has been targeted by a number of drugs to inhibit cancer cell survival and growth (4). Recently, physical cues from microenvironments have emerged as important regulators of tumor biology, such as extracellular matrix stiffness and collagen architecture (5, 6). Matrix stiffness also regulates normal hematopoiesis (7,8). However, the relevance of physical cues to blood cancer remains largely unclear. Importantly, how different cancer subtypes with distinct oncogenic mutations respond to matrix stiffness also remains to be investigated.Recent studies highlight the utility of adapting 3D culture into a high-throughput ...