Proteomic subtypes enrich current acute myeloid leukemia nomenclature and reflect intrinsic pathogenesis alongside aging

W Wen-Yan Cheng (Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine) X Xiao Yi Z Zhen-Yi Wang (Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine) J Jian-Feng Li (Xiamen University , , ,) J Jun-Yi Zhang (1Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China) R Rui-Hong Zhang (1Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China) Q Qian-Qian Zhang (Department of Chemistry) X Xiang-Qin Weng (Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine) T Ting Huang Y Yong-Mei Zhu (Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine) C Chao Wang W Wei Yin J Jia-Nan Zhang (1Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China) H Hui-Yi Wu (1Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China) J Jun-Min Li H Hong-Ming Zhu (Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine) L Li Chen W Wen-Fang Wang (1Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China) Y Yu-Ting Dai (Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine) C Chen-Xu Gao (Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine) X Xuan Liu (School of Energy and Power Engineering) S Shan Wang (Ministry of Education Key Laboratory of Cluster Science, Frontiers Science Center for High Energy Material, School of Interdisciplinary Science, School of Chemistry and Chemical Engineering) S Sheng-Yue Wang (Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine) B Bo Jiao (Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine) Z Zhu Chen (Key Laboratory of Biomedical Polymers of Ministry of Education, Department of Chemistry, Department of Cardiology, Zhongnan Hospital) H Hai Fang (Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine) T Tong Yin (Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine) Y Yang Shen (Beijing National Laboratory for Condensed Matter Physics, Institute of Physics) S Sai-Juan Chen (Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine)

Abstract

Abstract Acute myeloid leukemia (AML) is a highly heterogeneous hematological malignancy that increasingly affects the older population, with its posttranscriptional landscape remaining largely elusive. Establishing a stable proteomics-based classification system and systematically screening age-related proteins and regulatory networks are crucial for understanding the pathogenesis and outcomes of AML. In this study, we leveraged a multiomics cohort of 374 patients newly diagnosed with AML, integrating proteome, phosphoproteome, genome, transcriptome, and drug screening data. Through similarity network fusion clustering, we established 8 proteomic subtypes with distinct clinical and molecular properties, including S1 (CEBPA mutations), S3 (myelodysplasia-related AML), S4 (PML::RARA), S5 (NPM1 mutations), S6 (PML::RARA and RUNX1::RUNX1T1), S8 (CBFB::MYH11), S2 and S7 (mixed), aligning well with and adding actionable value to the latest World Health Organization nomenclature of AML. Hematopoietic lineage profiling of proteins indicated that megakaryocyte/platelet- and immune-related networks characterized distinct aging patterns in AML, which were consistent with our recent findings at the RNA level. Phosphosites also demonstrated distinct age-related features. The high protein abundance of megakaryocytic signatures was observed in S2, S3, and S7 subtypes, which were associated with advanced age and dismal prognosis of patients. A hematopoietic aging score with an independent prognostic value was established based on proteomic data, where higher scores correlated with myelodysplasia-related AML, NPM1 mutations, and clonal hematopoiesis-related gene mutations. Collectively, this study provides an overview of the molecular circuits and regulatory networks of AML during the aging process, advancing current classification systems and offering a comprehensive perspective on the disease.

Article Details

Journal Blood
Volume / Issue Vol. 146, Issue 22
Published November 27, 2025
Pages 2681-2695
ISSN 0006-4971
Publisher Elsevier BV

Journal Info

Blood

Elsevier BV

ISSN: 0006-4971 Health Sciences

Authors (29)

W

Wen-Yan Cheng

Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine

X

Xiao Yi

Z

Zhen-Yi Wang

Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine

J

Jian-Feng Li

Xiamen University , , ,

J

Jun-Yi Zhang

1Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

R

Rui-Hong Zhang

1Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

Q

Qian-Qian Zhang

Department of Chemistry

X

Xiang-Qin Weng

Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine

T

Ting Huang

Y

Yong-Mei Zhu

Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine

C

Chao Wang

W

Wei Yin

J

Jia-Nan Zhang

1Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

H

Hui-Yi Wu

1Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

J

Jun-Min Li

H

Hong-Ming Zhu

Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine

L

Li Chen

W

Wen-Fang Wang

1Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

Y

Yu-Ting Dai

Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine

C

Chen-Xu Gao

Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine

X

Xuan Liu

School of Energy and Power Engineering

S

Shan Wang

Ministry of Education Key Laboratory of Cluster Science, Frontiers Science Center for High Energy Material, School of Interdisciplinary Science, School of Chemistry and Chemical Engineering

S

Sheng-Yue Wang

Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine

B

Bo Jiao

Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine

Z

Zhu Chen

Key Laboratory of Biomedical Polymers of Ministry of Education, Department of Chemistry, Department of Cardiology, Zhongnan Hospital

H

Hai Fang

Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine

T

Tong Yin

Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine

Y

Yang Shen

Beijing National Laboratory for Condensed Matter Physics, Institute of Physics

S

Sai-Juan Chen

Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Research Unit of Hematologic Malignancies Genomics and Translational Research of Chinese Academy of Medical Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine