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Supplementary Information

Identification of genes associated with chemotherapy cross-resistance and treatment response in childhood acute lymphoblastic leukemia.

Supplemental Figure 9: VCR-ASP discordant resistance adds predictive value related to relapse-free survival to single-drug resistance of PRD-VCR-ASP-DNR in patients with ALL.

Disease-free survival using the COALL/DCOG cohort (n=127) subdivided into equal groups (1/3) using the single PVAD resistance score (panel A). After stratification by PVAD, the worst group (n=41) was further divided into equal groups (1/2) by the VCR-ASP discordant resistance gene expression (VCR-ASP) score (panel B), revealing significant further discrimination by the VCR-ASP discordant resistance gene expression pattern. Shown is the disease-free survival in St. Jude patients (n=92), divided by the single PVAD resistance score defined by the COALL/DCOG cohort (panel C). After stratification by PDAV gene expression score, the worst group (n=19) was further divided into equal groups (1/2) by the multiple drug resistance (CR) gene expression score (panel D). After stratification by PVAD gene expression score, the worst group (n=19) was further sub-grouped (1/2) by the VCR-ASP discordant resistance gene expression score (panel D). Patients whose ALL cells exhibit a gene expression pattern indicative of both worst cross-resistance and worst VCR-ASP discordant resistance scores (i.e., the worst 25% of both CR- and VCR-ASP-scores are depicted in panel E. The 5-year treatment outcome of patients with both types of multiple-drug resistance (most unfavorable quartile for both CR and VCR-ASP) was 37%13%, compared to 91%9% in patients in the best quartile for both scores.

Figure 9

E

Figure 9

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