TP53 deficiency in AML induces resistance to T-cell engagers through an immunosuppressive secretome

Bispecific T-cell engagers (BiTE^® molecules) have transformed the treatment of B-cell malignancies, yet clinical activity in AML has been modest. Resistance is driven in part by the genetic heterogeneity of AML, most notably TP53 mutations, present in 10-15% of de novo and up to 25% of therapy-related AML. Thus, we hypothesized that TP53 aberrations in AML contribute to cell-intrinsic and extrinsic resistance against T-cell-based immunotherapy. Cytotoxicity against TP53-deleted (DEL) primary AML cells and TP53-knockdown (KD) AML cell lines was reduced in co-cultures with T cells stimulated with the BiTE molecule AMG 330 (CD3×CD33). In addition, T-cell proliferation and proinflammatory cytokine secretion was impaired in co-cultures with TP53 KD cells. Transwell assays identified the secretome of TP53 KD AML cells as a key contributor to the immunosuppressive effects. Proteomic analysis revealed TGF-β1 in TP53 KD co-cultures as a mediator of T-cell suppression. RNA sequencing of T cells co-cultured with TP53 KD cells uncovered a transcriptional shift toward a senescent cell cycle profile. Our data collectively identify the immunosuppressive secretome of TP53-deficient AML as a key barrier to T-cell-engaging immunotherapies, underscoring an unmet clinical need for strategies able to restore T-cell function in TP53 KD AML.