Thrombopoietin (TPO), the major growth factor for cells of the megakaryocytic lineage, is removed from circulation by binding to c-mpl receptors present on platelets and megakaryocytes. We studied patients with acute lymphoblastic leukemia (ALL) or acute myeloblastic leukemia (AML) and used TPO-induced c-fos protein up-regulation as a marker of cmpl functionality and observed that cmpl-presenting blast cells were present in 62% (37 of 60) of patients with ALL but that c-mpl was nonfunctional in 0 of 28 patients and that they were present in 56% (22 of 39) of patients with AML and were functional in 43% (12 of 28). Adequate increases in serum TPO level in response to thrombocytopenia were seen in patients with ALL and with c-mpldeficient (c-mpl ؊) AML. In contrast, in patients with c-mpl-proficient (c-mpl ؉ ) AML, TPO levels were found to be inappropriately low but increased to expected values during induction chemotherapy as blasts disappeared. In vitro significant TPO-associated blast cell proliferation or decreased apoptosis was observed only in patients with c-mpl ؉ AML compared with ALL or c-mpl ؊ AML and was highly correlated with low in vivo TPO levels (P < .001). These data suggest that, in patients with AML, inadequate TPO levels are secondary to TPO clearing by functional c-mpl receptor myeloid blast cells and that TPO may serve as an in vivo myeloid leukemic growth factor in a significant number of patients.
IntroductionThrombopoietin (TPO) serum levels are controlled by a regulatory loop consisting of TPO consumption by target cells, platelets, and megakaryocytes (MGKs) through TPO c-mpl receptor-mediated absorption. 1 Thus, serum TPO level correlates inversely with platelet count in patients with hypoplastic thrombocytopenia, including chemotherapy-induced thrombocytopenia, 2-4 aplastic anemia, 5-7 myelodysplastic syndromes (MDS), and congenital amegakaryocytosis, 8 whereas no correlation is observed in patients with hyperdestructive thrombocytopenia 5 ; c-mpl has been observed on the surfaces of myeloid and lymphoid human blast cancer cells. 9-14 TPO in vitro induces cell cycle activation in human acute myeloblastic leukemia (AML) blast cells, 9,10,12,13 protects these cells from programmed cell death, 13 and, in TPO nonresponding cells, is synergistic with other growth factors to support the growth of leukemic myeloid blast cells. 9,12 Until now, no study has evaluated the relationship between serum TPO levels and the presence of c-mpl functional receptor on leukemic blast cells. However, through the evaluation of endogenous TPO level in patients with MDS and refractory anemia, it was found that though TPO level correlates inversely with platelet count in patients with refractory anemia, such correlation was not observed in patients with refractory anemia with excess blasts. This suggested that regulatory pathways other than thrombocytopenia, such as blast-expressing c-mpl, might operate in MDS. 15 In this study, we evaluated at the time of diagnosis serum TPO levels and functional c-mpl blast ce...