Coexisting with Clonal Evolution and BCR-ABL Mutant in CML Patients Treated with Second-generation Tyrosine Kinase Inhibitors Predict the Discrepancy of in vitro Drug Sensitivity.
- Author:
Jae Sook AHN
1
;
Yeo Kyeoung KIM
;
Se Ryeon LEE
;
Li YU
;
Deok Hwan YANG
;
Sang Hee CHO
;
Hyun Jeong SHIM
;
Woo Kyun BAE
;
Je Jung LEE
;
Ik Joo CHUNG
;
Myung Gun SHIN
;
Hyeoung Joon KIM
Author Information
1. Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea. hjoonk@chonnam.ac.kr
- Publication Type:In Vitro ; Original Article
- Keywords:
CML;
Dasatinib;
Nilotinib;
Clonal evolution;
BCR-ABL mutation
- MeSH:
Benzamides;
Chromosome Aberrations;
Clonal Evolution;
Clone Cells;
Cytogenetics;
Dasatinib;
Humans;
Hydrogen-Ion Concentration;
Kinetics;
Leukemia, Myelogenous, Chronic, BCR-ABL Positive;
Metaphase;
Philadelphia;
Phosphotransferases;
Piperazines;
Protein-Tyrosine Kinases;
Pyrimidines;
Thiazoles;
Tyrosine;
Imatinib Mesylate
- From:Cancer Research and Treatment
2010;42(1):37-41
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Second-generation tyrosine kinase inhibitors (second TKIs) such as nilotinib and dasatinib control the activity of most ABL kinase domain mutations observed in patients with imatinib resistance. Although in vitro data show that both agents can inhibit all mutations except T315I, some discrepancies have been observed in a small subset of mutation clones. Cytogenetic clonal evolution is the important resistance mechanism of chronic myeloid leukemia (CML). Accordingly, we observed the clinical significance of coexisting with clonal evolution and BCR-ABL mutant in CML patients treated with second TKIs. MATERIALS AND METHODS: We monitored BCR-ABL transcript kinetics, interrelationship of clones expressing non-mutated and mutant transcripts and clonal aberrations within Philadelphia (Ph) positive and negative clones, respectively, in eight patients with CML receiving dasatinib or nilotinib for 3~41 months. RESULTS: Clinical responses were correlated with in vitro sensitivity of the BCR-ABL mutants to the second TKIs in four patients. Four patients showed resistance to the second TKIs as compared to in vitro observations; three of them developed chromosomal abnormalities in the Ph chromosome positive or negative metaphases. Another patient lost the original mutation but acquired a more resistant new mutation and became resistant to the second TKI. CONCLUSION: Cytogenetic clonal evolution is an independent poor prognostic factor in CML, which could explain the onset of mechanisms for second TKIs resistance to ABL kinase domain mutations. The results indicate that an additional evaluation of chromosomal abnormalities is warranted when BCR-ABL mutants are more resistant than indicated by in vitro data.
