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ResearchIn-Press PreviewCell biologyClinical ResearchHematology Open Access | 10.1172/JCI204701

XY0206 targets FLT3-dependent resistance states in acute myeloid leukemia

Long Shen,1 Yang Yang,1 Chenghua Xu,2 Bo Jiang,1 Xiaoxiao Duan,1 Xianfeng Shao,1 Simeng Li,1 Siyi Liu,1 Chao Huang,3 Lin Song,1 Mingyuan Sun,1 Jinting Fan,1 Ning Wang,1 Dong Zhang,1 Youyang Fang,1 Lichun Kang,4 Yajun Jiang,3 Mingming Niu,1 Junyuan Qi,1 Tao Cheng,1 and Hong Wang1

1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Ac, Tianjin, China

2Haihe Laboratory of Cell Ecosystem, Tianjin Medical University, Tianjin, China

3tate Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Chemistry and Biomedicine Innovation Center (ChemBIC), Nanjing University, Nanjing, China

4Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China

Find articles by Shen, L. in: PubMed | Google Scholar

1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Ac, Tianjin, China

2Haihe Laboratory of Cell Ecosystem, Tianjin Medical University, Tianjin, China

3tate Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Chemistry and Biomedicine Innovation Center (ChemBIC), Nanjing University, Nanjing, China

4Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China

Find articles by Yang, Y. in: PubMed | Google Scholar

1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Ac, Tianjin, China

2Haihe Laboratory of Cell Ecosystem, Tianjin Medical University, Tianjin, China

3tate Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Chemistry and Biomedicine Innovation Center (ChemBIC), Nanjing University, Nanjing, China

4Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China

Find articles by Xu, C. in: PubMed | Google Scholar

1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Ac, Tianjin, China

2Haihe Laboratory of Cell Ecosystem, Tianjin Medical University, Tianjin, China

3tate Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Chemistry and Biomedicine Innovation Center (ChemBIC), Nanjing University, Nanjing, China

4Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China

Find articles by Jiang, B. in: PubMed | Google Scholar

1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Ac, Tianjin, China

2Haihe Laboratory of Cell Ecosystem, Tianjin Medical University, Tianjin, China

3tate Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Chemistry and Biomedicine Innovation Center (ChemBIC), Nanjing University, Nanjing, China

4Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China

Find articles by Duan, X. in: PubMed | Google Scholar

1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Ac, Tianjin, China

2Haihe Laboratory of Cell Ecosystem, Tianjin Medical University, Tianjin, China

3tate Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Chemistry and Biomedicine Innovation Center (ChemBIC), Nanjing University, Nanjing, China

4Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China

Find articles by Shao, X. in: PubMed | Google Scholar

1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Ac, Tianjin, China

2Haihe Laboratory of Cell Ecosystem, Tianjin Medical University, Tianjin, China

3tate Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Chemistry and Biomedicine Innovation Center (ChemBIC), Nanjing University, Nanjing, China

4Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China

Find articles by Li, S. in: PubMed | Google Scholar

1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Ac, Tianjin, China

2Haihe Laboratory of Cell Ecosystem, Tianjin Medical University, Tianjin, China

3tate Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Chemistry and Biomedicine Innovation Center (ChemBIC), Nanjing University, Nanjing, China

4Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China

Find articles by Liu, S. in: PubMed | Google Scholar

1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Ac, Tianjin, China

2Haihe Laboratory of Cell Ecosystem, Tianjin Medical University, Tianjin, China

3tate Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Chemistry and Biomedicine Innovation Center (ChemBIC), Nanjing University, Nanjing, China

4Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China

Find articles by Huang, C. in: PubMed | Google Scholar

1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Ac, Tianjin, China

2Haihe Laboratory of Cell Ecosystem, Tianjin Medical University, Tianjin, China

3tate Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Chemistry and Biomedicine Innovation Center (ChemBIC), Nanjing University, Nanjing, China

4Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China

Find articles by Song, L. in: PubMed | Google Scholar

1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Ac, Tianjin, China

2Haihe Laboratory of Cell Ecosystem, Tianjin Medical University, Tianjin, China

3tate Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Chemistry and Biomedicine Innovation Center (ChemBIC), Nanjing University, Nanjing, China

4Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China

Find articles by Sun, M. in: PubMed | Google Scholar

1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Ac, Tianjin, China

2Haihe Laboratory of Cell Ecosystem, Tianjin Medical University, Tianjin, China

3tate Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Chemistry and Biomedicine Innovation Center (ChemBIC), Nanjing University, Nanjing, China

4Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China

Find articles by Fan, J. in: PubMed | Google Scholar

1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Ac, Tianjin, China

2Haihe Laboratory of Cell Ecosystem, Tianjin Medical University, Tianjin, China

3tate Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Chemistry and Biomedicine Innovation Center (ChemBIC), Nanjing University, Nanjing, China

4Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China

Find articles by Wang, N. in: PubMed | Google Scholar

1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Ac, Tianjin, China

2Haihe Laboratory of Cell Ecosystem, Tianjin Medical University, Tianjin, China

3tate Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Chemistry and Biomedicine Innovation Center (ChemBIC), Nanjing University, Nanjing, China

4Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China

Find articles by Zhang, D. in: PubMed | Google Scholar

1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Ac, Tianjin, China

2Haihe Laboratory of Cell Ecosystem, Tianjin Medical University, Tianjin, China

3tate Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Chemistry and Biomedicine Innovation Center (ChemBIC), Nanjing University, Nanjing, China

4Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China

Find articles by Fang, Y. in: PubMed | Google Scholar

1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Ac, Tianjin, China

2Haihe Laboratory of Cell Ecosystem, Tianjin Medical University, Tianjin, China

3tate Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Chemistry and Biomedicine Innovation Center (ChemBIC), Nanjing University, Nanjing, China

4Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China

Find articles by Kang, L. in: PubMed | Google Scholar

1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Ac, Tianjin, China

2Haihe Laboratory of Cell Ecosystem, Tianjin Medical University, Tianjin, China

3tate Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Chemistry and Biomedicine Innovation Center (ChemBIC), Nanjing University, Nanjing, China

4Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China

Find articles by Jiang, Y. in: PubMed | Google Scholar

1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Ac, Tianjin, China

2Haihe Laboratory of Cell Ecosystem, Tianjin Medical University, Tianjin, China

3tate Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Chemistry and Biomedicine Innovation Center (ChemBIC), Nanjing University, Nanjing, China

4Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China

Find articles by Niu, M. in: PubMed | Google Scholar

1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Ac, Tianjin, China

2Haihe Laboratory of Cell Ecosystem, Tianjin Medical University, Tianjin, China

3tate Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Chemistry and Biomedicine Innovation Center (ChemBIC), Nanjing University, Nanjing, China

4Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China

Find articles by Qi, J. in: PubMed | Google Scholar

1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Ac, Tianjin, China

2Haihe Laboratory of Cell Ecosystem, Tianjin Medical University, Tianjin, China

3tate Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Chemistry and Biomedicine Innovation Center (ChemBIC), Nanjing University, Nanjing, China

4Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China

Find articles by Cheng, T. in: PubMed | Google Scholar |

1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Ac, Tianjin, China

2Haihe Laboratory of Cell Ecosystem, Tianjin Medical University, Tianjin, China

3tate Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Chemistry and Biomedicine Innovation Center (ChemBIC), Nanjing University, Nanjing, China

4Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China

Find articles by Wang, H. in: PubMed | Google Scholar

Published September 1, 2026 - More info

J Clin Invest. https://doi.org/10.1172/JCI204701.
Copyright © 2026, Shen et al. This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
Published September 1, 2026 - Version history
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Abstract

Activating mutations in FMS-like tyrosine kinase 3 (FLT3) drive aggressive acute myeloid leukemia (AML) and confer poor prognosis. Although FLT3 inhibitors have improved outcomes, their efficacy is frequently limited by microenvironment-mediated signaling and treatment-emergent resistance. XY0206 is a structurally optimized derivative of sunitinib, an inhibitor approved for multiple solid tumors. Biochemical, multi-omics, and functional analyses showed that XY0206 directly engages FLT3 and suppresses downstream STAT5, AKT, and ERK signaling, resulting in apoptosis in FLT3-ITD AML cells. Across models of FLT3-dependent resistance, XY0206 retained antileukemic activity, including in FLT3-ITD cells harboring the F691L gatekeeper mutation, a recurrent alteration conferring resistance to approved FLT3 inhibitors. In primary AML blasts and xenograft models, XY0206 exhibited enhanced antileukemic activity with favorable tolerability relative to gilteritinib. In a phase I/II trial (NCT04471064) of XY0206 monotherapy in patients with relapsed or refractory (R/R) AML, XY0206 achieved a composite complete remission rate (CRc) of 45.7% overall, with a notable 60.0% CRc rate among patients with FLT3-ITD mutations. Three of eight patients with prior FLT3 inhibitor-exposed R/R AML also achieved CRc. Together, these findings support further clinical evaluation of XY0206 as a FLT3-directed therapeutic in AML, particularly in disease settings with reduced sensitivity to existing FLT3 inhibitors.

Supplemental material

View Supplemental Table 1. Enzymatic activity of XY0206 against a 217-kinase panel at 100 nM.

View Supplemental Table 2. Differentially expressed proteins identified by quantitative proteomic profiling of FLT3-ITD AML cells treated with sunitinib or XY0206.

View Supplemental Table 3. Global phosphoproteomic dataset of FLT3-ITD AML cells following treatment with sunitinib or XY0206.

View Supplemental Table 4. Tyrosine-phosphoproteomic dataset of FLT3-ITD AML cells following treatment with sunitinib or XY0206.

View Supplemental Table 5. Whole exome sequencing identified genetic alterations in gilteritinib-resistant AML cell models.

View Supplemental Table 6. Clinical and molecular characteristics of primary AML samples used for ex vivo evaluation of XY0206 activity.

View Unedited blot and gel images

View

View Supplemental Table 7. Clinical and disease characteristics of patients with R/R AML enrolled in the Phase I/II trial of XY0206 monotherapy.

View Supplemental Table 8. Incidence of treatment-emergent adverse events in patients with R/R AML treated with XY0206.

Version history
  • Version 1 (September 1, 2026): In-Press Preview

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