IGF1 and acute myeloid leukemia: In addition, AML-derived exosomes induce downregulation of HSC-supporting factors (eg, CXCL12, KITL, and IGF1) in BM stromal cells, reducing their capacity to support normal hematopoiesis.66 Doron and colleagues87 demonstrated that AML cells can use extracellular vesicles to transmit endoplasmic reticulum stress and to promote the unfolded protein response in stromal cells, inducing their osteogenic commitment partially through the transfer of BMP2.