CBFB-MYH11 fusion neoantigen enables T cell recognition and killing of acute myeloid leukemia

Proteins created from recurrent fusion genes like CBFB-MYH11 are prevalent in acute myeloid leukemia (AML), often necessary for leukemogenesis, persistent throughout the disease course, and highly leukemia specific, making them attractive neoantigen targets for immunotherapy. A nonameric peptide derived from a prevalent CBFB-MYH11 fusion protein was found to be immunogenic in HLA-B*40:01* donors. High-avidity CD8(+) T cell clones isolated from healthy donors killed CBFB-MYHir HLA-B*40:01(+) AML cell lines and primary human AML samples in vitro. CBFB-MYH11-specific T cells also controlled CBFB-MYH11(+) HLA-B*40:01(+) AML in vivo in a patient-derived murine xenograft model. High-avidity CBFBM-YH11 epitope-specific T cell receptors (TCRs) transduced into CO8 . T cells conferred antileukemic activity in vitro. Our data indicate that the CBFB-MYH11 fusion neoantigen is naturally presented on AML blasts and enables T cell recognition and killing of AML. We provide proof of principle for immunologically targeting AML-initiating fusions and demonstrate that targeting neoantigens has clinical relevance even in low-mutational frequency cancers like fusion-driven AML. This work also represents a first critical step toward the development of TCR T cell immunotherapy targeting fusion gene-driven AML.