1
|
Kee KM, Kim SH, Yang SY, Shin JU, Nam YW, Jang EJ, Kim HT, Lee SM, Park SH, Kim DW. Comparison of 3-month cytogenetic and molecular assays for early assessment of long-term clinical impact after BCR-ABL1 tyrosine kinase inhibitor treatment in chronic myeloid leukemia. Leuk Res 2021; 112:106754. [PMID: 34906861 DOI: 10.1016/j.leukres.2021.106754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/09/2021] [Accepted: 11/21/2021] [Indexed: 11/29/2022]
Abstract
To compare the clinical significance of 3-month cytogenetic and molecular monitoring, we analyzed 1,410 paired cytogenetic and molecular data from 705 chronic-phase chronic myeloid leukemia patients. Based on early cytogenetic response (ECyR, Ph+≤35 %) and molecular response (EMR, BCR-ABL1IS≤10 %) at 3 months, the patients were divided into four groups (group 1: ECyR + EMR, n = 560; group 2: no ECyR + EMR, n = 27; group 3: ECyR + no EMR, n = 55; group 4: no ECyR + no EMR, n = 63). By 10 years, major molecular response (MMR), deep molecular response (MR4.5), overall survival (OS), and progression-free survival (PFS) rates were significantly high in group 1 (P < 0.001). Comparing groups 2 and 3, the MMR (P = 0.096), MR4.5 (P = 0.945), OS (P = 0.832), and PFS (P = 0.627) rates tended to be higher in group 2, although not significantly. Thus, the cytogenetic assay can not only be useful but its addition may also provide a more precise prediction of MR4.5.
Collapse
Affiliation(s)
- Kyung-Mi Kee
- Leukemia Research Institute, The Catholic University of Korea, Seoul, South Korea
| | - Soo-Hyun Kim
- Leukemia Research Institute, The Catholic University of Korea, Seoul, South Korea
| | - Seon-Young Yang
- Leukemia Research Institute, The Catholic University of Korea, Seoul, South Korea
| | - Jeong-U Shin
- Leukemia Research Institute, The Catholic University of Korea, Seoul, South Korea
| | - Yoon-Won Nam
- Leukemia Research Institute, The Catholic University of Korea, Seoul, South Korea
| | - Eun-Jung Jang
- Leukemia Research Institute, The Catholic University of Korea, Seoul, South Korea
| | - Hong-Tae Kim
- Department of Biological Sciences, Ulsan National Institute of Science and Technology (UNIST), Ulsan, South Korea; Center for Genomic Integrity, Institute for Basic Science (IBS), UNIST, Ulsan, South Korea
| | - Se-Min Lee
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, South Korea
| | - Sung-Ho Park
- Department of Biological Sciences, Ulsan National Institute of Science and Technology (UNIST), Ulsan, South Korea
| | - Dong-Wook Kim
- Leukemia Research Institute, The Catholic University of Korea, Seoul, South Korea; Catholic Hematology Hospital, The Catholic University of Korea, Seoul, South Korea.
| |
Collapse
|
2
|
Shanmuganathan N, Branford S. Multiplex technologies for the assessment of minimal residual disease and low-level mutation detection in leukaemia: mass spectrometry versus next-generation sequencing. Br J Haematol 2021; 196:19-30. [PMID: 34124782 DOI: 10.1111/bjh.17623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 01/07/2023]
Abstract
With the focus of leukaemia management shifting to the implications of low-level disease burden, increasing attention is being paid on the development of highly sensitive methodologies required for detection. There are various techniques capable of identification of measurable residual disease (MRD) either evidencing as relevant mutation detection [e.g. nucleophosmin 1 (NPM1) mutation] or trace levels of leukaemic clonal populations. The vast majority of these methods only permit detection of a single clone or mutation. However, mass spectrometry and next-generation sequencing enable the interrogation of multiple genes simultaneously, facilitating a more complete genomic profile. In the present review, we explore the methodologies of both techniques in conjunction with the important advantages and limitations associated with each assay. We also highlight the evidence and the various instances where either technique has been used and propose future strategies for MRD detection.
Collapse
Affiliation(s)
- Naranie Shanmuganathan
- Department of Haematology, Royal Adelaide Hospital and SA Pathology, Adelaide, South Australia, Australia.,Department of Genetics and Molecular Pathology and Centre for Cancer Biology, SA Pathology, Adelaide, South Australia, Australia.,Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.,School of Pharmacy and Medical Science, University of South Australia, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Susan Branford
- Department of Genetics and Molecular Pathology and Centre for Cancer Biology, SA Pathology, Adelaide, South Australia, Australia.,Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.,School of Pharmacy and Medical Science, University of South Australia, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
3
|
Rostami G, Hamid M, Jalaeikhoo H. Impact of the BCR - ABL1 fusion transcripts on different responses to Imatinib and disease recurrence in Iranian patients with Chronic Myeloid Leukemia. Gene 2017. [DOI: 10.1016/j.gene.2017.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
4
|
New Tool for Monitoring Molecular Response in Patients With Chronic Myeloid Leukemia. Appl Immunohistochem Mol Morphol 2017; 27:33-39. [PMID: 28682832 DOI: 10.1097/pai.0000000000000526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Chronic myeloid leukemia treatment monitoring using polymerase chain reaction-based peripheral blood testing of t9;22 BCR-ABL1 provides improved test sensitivity over cytology but suffers from inadequate standardization in most laboratories due to variations inherent in the existing polymerase chain reaction methodologies. We performed the initial analytic performance evaluation of a novel competitive template-based peripheral blood b2a2/b3a2 transcript abundance method, called standardized nucleic acid quantification (SNAQ) test, with hypothesis that this will produced more consistent results with less frequent interlaboratory variations. MATERIALS AND METHODS Thirty-six chronic myeloid leukemia patients treated at our institution were enrolled. We compared SNAQ test with 2 laboratory developed test at the MD Anderson molecular diagnostic laboratory and Cancer Genetics Institute for analyzing BCR-ABL1 from peripheral blood samples. Each test result (n=36) was ranked against all the other samples tested by the same method. RESULTS The Pearson correlation between SNAQ and laboratory developed test done at 2 labs was met by correlations of 0.97, 0.96, 0.96, and 0.94. Analysis of variance of log %BCR-ABL1 interlaboratory results indicated no significant difference (P=0.98). Post hoc analysis of method agreement showed the SNAQ method had a 95% limit of agreement of ±3-fold between laboratories. CONCLUSIONS In this pilot study, SNAQ methodology performed consistent with half-log accuracy. Additional studies from a larger sample size and correlation with clinical outcomes are required to confirm this observation.
Collapse
|
5
|
Branford S. Monitoring and defining early response: Where to draw the line? Best Pract Res Clin Haematol 2016; 29:284-294. [DOI: 10.1016/j.beha.2016.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/10/2016] [Indexed: 11/26/2022]
|
6
|
Chikkodi SV, Malhotra P, Naseem S, Khadwal A, Prakash G, Sahu KK, Kumari S, Suri V, Varma N, Varma S. Factors Affecting Early Molecular Response in Chronic Myeloid Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 15 Suppl:S114-9. [PMID: 26297263 DOI: 10.1016/j.clml.2015.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 03/18/2015] [Indexed: 01/06/2023]
Abstract
OBJECTIVES There is controversy about whether 3- or 6-month molecular assessment predicts progression-free and overall survival in those with chronic myeloid leukemia (CML). The factors predicting molecular response at 3, 6, and 12 months have not been studied extensively. The study objective was to study the factors affecting molecular response at 3 and 6 months in patients with CML who are receiving imatinib mesylate. METHODS We prospectively enrolled patients with newly diagnosed CML who were receiving imatinib mesylate as the initial therapy for CML. The diagnosis of CML was based on clinical examination, bone marrow, and demonstration of BCR ABL(IS) transcripts by polymerase chain reaction. The molecular response(IS) was assessed at 3, 6, and 12 months by GeneXpert (Cepheid, Sunnyvale, CA) and co-related with various baseline characteristics of patients. We also looked at whether early achievement of a complete hematologic response within 6 weeks predicts molecular response at 3 or 6 months. The study took place at a tertiary care hospital in Northwest India catering to patients belonging to low-middle socioeconomic status. RESULTS We enrolled 131 patients with CML in the chronic phase from July 1, 2013, to August 31, 2014. The median age of the patients was 40 years (range, 13-67) with a male preponderance (61% were male). Most patients presented with symptoms of low-grade fever (52.7%) and abdominal fullness (26.7%). Spleen was palpable in 84.7% of patients. The median hemoglobin at presentation was 10.8 g/dL (range, 4.8-18.4 g/dL), white cell count was 138.3 × 10(9)/L (4.1-697 × 10(9)/L), and platelet count was 326 × 10(9)/L (85-1819 × 10(9)/L). The median number of peripheral blood basophils was 3% (range, 0%-20%), and blasts were 3% (range, 0%-10%). Myelofibrosis of more than grade 1 was present in 30% of patients. Most patients belonged to intermediate Sokal (45.8%) and Hasford (55%) scores and low EUropean Treatment Outcome Study (78.6%) score. Of 128 evaluable patients at 3 months, 96.9% achieved complete hematologic remission (CHR) and 82.3% achieved BCR ABL(IS) of less than 10%. None of the patients who had BCR ABL(IS) > 10% at 3 months achieved BCR ABL(IS) < 1% at 6 months or < 0.1% at 12 months. Early achievement of CHR (< 6 weeks), peripheral blood blast count of < 5%, and lactate dehydrogenase < 851 U/L were significantly associated with achievement of BCR ABL(IS) < 10% at 3 months and BCR ABL(IS) < 1% at 6 months. CONCLUSIONS We found that BCR ABL(IS) assessment at 3 months is superior to assessment at 6 months. Patients with CML in the chronic phase who achieve CHR within 6 weeks are more likely to achieve BCR ABL(IS) < 10% at 3 months and < 1% at 6 months than patients who achieve CHR between 7 and 12 weeks.
Collapse
Affiliation(s)
- Santosh V Chikkodi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Shano Naseem
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Khadwal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Prakash
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamal Kant Sahu
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Kumari
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Suri
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Varma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
7
|
Sissolak G, Badenhorst J, Steenkamp J, Heaney M, Louw V, Schnugh D, Willem P. Treatment Outcomes in CML Patients Treated With Tyrosine Kinase Inhibitors at a Tertiary Teaching Hospital in South Africa. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:803-10. [PMID: 26481837 DOI: 10.1016/j.clml.2015.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/04/2015] [Accepted: 09/11/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Chronic myeloid leukemia (CML) has become one of the most treatable hematologic neoplasms since the advent of the tyrosine kinase inhibitors (TKIs), but it was not known if similar treatment outcomes could be achieved in a resource-limited country. We tested the hypothesis that, despite challenges to access to second-generation TKIs, excellent responses could be replicated in the setting of limited resources. PATIENTS AND METHODS Records of 58 patients with newly diagnosed CML in the chronic phase treated with TKIs at a tertiary teaching hospital in Cape Town, South Africa between 2003 and 2012 were reviewed and assessed according to European LeukemiaNet (ELN) criteria. RESULTS After a median follow-up of 60.5 months, progression-free survival at 60 and 96 months was 79.98% and 68.4%, respectively. Overall survival at 60 and 96 months was 92.9% and 83.6%, respectively. Progression to blast phase at 60 months was associated with poorer survival (P = .0002) but progression to accelerated phase was not (P = .1456). Attainment of a complete cytogenetic response at 12 months (P = .28) or major molecular response at 18 months (P = .268) did not have prognostic significance. CONCLUSION Despite delays in achievement of the target responses defined according to ELN criteria, the use of imatinib mesylate as a first-line treatment can still result in treatment outcomes comparable with those in developed countries. These data suggest opportunities for improvement and success might be even greater with uninterrupted access to second-generation or newer TKIs.
Collapse
Affiliation(s)
- Gerhard Sissolak
- Department of Internal Medicine, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa.
| | - Jacques Badenhorst
- Department of Internal Medicine, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa
| | - Janami Steenkamp
- Department of Pathology, National Health Laboratory Services (NHLS), University of Stellenbosch and Pathcare Laboratories, Cape Town, South Africa
| | - Mark Heaney
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Vernon Louw
- Department of Medicine, University of the Free State, Bloemfontein and Panorama Mediclinic, Cape Town, South Africa
| | - Desmond Schnugh
- Department of Haematology and Molecular Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Pascale Willem
- Department of Haematology and Molecular Medicine, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
8
|
Kelani R, Monem F. Reconsideration of BCR-ABL protein flow cytometric immunobead assay: how potent to diagnose and monitor chronic myeloid leukemia? Int J Lab Hematol 2015; 37:723-8. [PMID: 26059167 DOI: 10.1111/ijlh.12394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 05/17/2015] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Chronic myeloid leukemia (CML) is typically associated with the Philadelphia chromosome, resulting in the production of BCR-ABL fusion oncoprotein with upregulated tyrosine kinase activity. We aimed to evaluate a new flow cytometric immunobead assay to detect BCR-ABL protein in a group of patients with CML. METHODS We enrolled 49 patients with CML, whose qRT-PCR and/or cytogenetic analysis of Philadelphia chromosome aberration was available, including tyrosine kinase inhibitors (TKIs)-naïve and (TKIs)-treated patients with various levels of response. Twenty Philadelphia-negative healthy individuals were also enrolled to obtain analytical negative controls. Peripheral blood samples were analyzed for BCR-ABL fusion protein by flow cytometry. RESULTS The BCR-ABL fusion protein flow cytometric assay seemed efficacious to both diagnose the presence (P-value <0.0001) and distinguish the levels (P-value = 0) of the Philadelphia chromosome aberration. Groups of TKI-naïve and TKI-treated patients as well as levels of molecular/cytogenetic response to TKI-therapy were effectively discriminated (P-value <0.01). The receiver operating characteristic (ROC) curve analysis indicated the diagnostic value of the assay as excellent (AUC = 0.95, P-value = 0). CONCLUSIONS The evaluated BCR-ABL fusion protein assay might be useful for diagnosing and monitoring Philadelphia chromosome aberration.
Collapse
Affiliation(s)
- R Kelani
- Department of Biochemistry and Microbiology, Faculty of Pharmacy, Damascus University, Damascus, Syria
| | - F Monem
- Department of Biochemistry and Microbiology, Faculty of Pharmacy, Damascus University, Damascus, Syria.,Clinical Laboratories Department, AL-Assad Hospital, Damascus University, Damascus, Syria
| |
Collapse
|
9
|
Lucas CM, Harris RJ, Giannoudis A, McDonald E, Clark RE. Low leukotriene B4 receptor 1 leads to ALOX5 downregulation at diagnosis of chronic myeloid leukemia. Haematologica 2014; 99:1710-5. [PMID: 25193960 DOI: 10.3324/haematol.2013.101972] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
ALOX5 is implicated in chronic myeloid leukemia development in mouse leukemic stem cells, but its importance in human chronic myeloid leukemia is unknown. Functional ALOX5 was assessed using an LTB4 ELISA and ALOX5, and LTB4R1 mRNA expression was determined via a TaqMan gene expression assay. LTB4R1 and 5-LOX protein levels were assessed by cell surface flow cytometry analysis. At diagnosis ALOX5 was below normal in both blood and CD34(+) stem cells in all patients. On treatment initiation, ALOX5 levels increased in all patients except those who were destined to progress subsequently to blast crisis. LTB4 levels were increased despite low ALOX5 expression, suggesting that the arachidonic acid pathway is functioning normally up to the point of LTB4 production. However, the LTB4 receptor (BLT1) protein in newly diagnosed patients was significantly lower than after a period of treatment (P<0.0001). The low level of LTB4R1 at diagnosis explains the downregulation of ALOX5. In the absence of LTB4R1, the arachidonic acid pathway intermediates (5-HEPTE and LTA4) negatively regulate ALOX5. ALOX5 regulation is aberrant in chronic myeloid leukemia patients and may not be important for the development of the disease. Our data suggest caution when extrapolating mouse model data into human chronic myeloid leukemia.
Collapse
Affiliation(s)
- Claire M Lucas
- Department of Molecular and Clinical Cancer Medicine (Haematology), University of Liverpool, UK
| | - Robert J Harris
- Department of Molecular and Clinical Cancer Medicine (Haematology), University of Liverpool, UK
| | - Athina Giannoudis
- Department of Molecular and Clinical Cancer Medicine (Haematology), University of Liverpool, UK
| | - Elizabeth McDonald
- Department of Molecular and Clinical Cancer Medicine (Haematology), University of Liverpool, UK
| | - Richard E Clark
- Department of Molecular and Clinical Cancer Medicine (Haematology), University of Liverpool, UK
| |
Collapse
|
10
|
Akard LP, Cortes JE, Albitar M, Goldberg SL, Warsi G, Wetzler M, Ericson SG, Radich JP. Correlations between cytogenetic and molecular monitoring among patients with newly diagnosed chronic myeloid leukemia in chronic phase: post hoc analyses of the Rationale and Insight for Gleevec High-Dose Therapy study. Arch Pathol Lab Med 2014; 138:1186-92. [PMID: 24308645 DOI: 10.5858/arpa.2013-0584-oa] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
CONTEXT Although bone marrow (BM) karyotyping has been the standard in monitoring patients with chronic myeloid leukemia, peripheral blood (PB) monitoring methods may be more convenient. OBJECTIVE To conduct post hoc analyses of the Rationale and Insight for Gleevec High-Dose Therapy study to evaluate correlations between results of cytogenetic testing and molecular monitoring from BM and PB during the first 18 months of high-dose imatinib therapy, and between early and late molecular responses. DESIGN Newly diagnosed patients with chronic-phase chronic myeloid leukemia received imatinib 400 mg twice daily and were monitored quarterly for up to 18 months. Cytogenetic testing was performed by karyotyping using BM or by fluorescence in situ hybridization using PB. Molecular testing was performed by quantitative reverse transcriptase polymerase chain reaction using BM and PB. RESULTS Significant pairwise correlations were found between results obtained by karyotyping, fluorescence in situ hybridization, and quantitative reverse transcriptase polymerase chain reaction using PB or BM (all pairwise correlations >0.8; P < .001). At 12 months, cytogenetic response by karyotyping correlated well with response by fluorescence in situ hybridization. A median 2.579-log reduction in BCR-ABL1 level from a standardized baseline correlated with fluorescence in situ hybridization-negative status. Patients with greater than 2-log reduction in BCR-ABL1 level at 3, 6, and 9 months were more likely to achieve major molecular response at 18 months than those with 2-log reduction or less. CONCLUSIONS Our findings support the feasibility of molecular monitoring using PB and suggest that molecular monitoring conducted at a single reliable reference laboratory can adequately track response without invasive BM testing. Our findings are consistent with other work indicating that early response to imatinib predicts favorable long-term outcome.
Collapse
Affiliation(s)
- Luke P Akard
- From the Indiana Blood and Marrow Transplantation, Stem Cell Transplantation Program, St. Francis Hospital and Health Centers, Indianapolis, Indiana (Dr Akard); the Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston (Dr Cortes); the Departments of Oncology/Hematopathology and Research and Development, NeoGenomics Laboratories, Irvine, California (Dr Albitar); the Division of Leukemia, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey (Dr Goldberg); Biostatistics (Dr Warsi) and Oncology Clinical Development (Dr Ericson), Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; the Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Wetzler); and the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (Dr Radich)
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Doval DC, Batra U, Goyal S, Sharma A, Azam S, Shirali R. Chronic myeloid leukemia treatment with Imatinib: An experience from a private tertiary care hospital. Indian J Med Paediatr Oncol 2014; 34:182-5. [PMID: 24516305 PMCID: PMC3902620 DOI: 10.4103/0971-5851.123725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The data presents 75 chronic myeloid leukemia patients diagnosed over a period 6 years i.e. from 2002 to 2008. The most common presentation was splenomegaly and 97% achieved complete hematological response at median duration of 4.3 weeks. The uniqueness of this study is follow-up with molecular response monitoring. Nearly, 30% patients achieved major molecular response (MMoR) by 12 months. 70% of patients achieved MMoR by median time of 60 months. Only 10% of the patient who achieved MMoR by 18 months had lost their responses subsequently.
Collapse
Affiliation(s)
- D C Doval
- Department of Medical Oncology and Research, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Ullas Batra
- Department of Medical Oncology and Research, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Sumit Goyal
- Department of Medical Oncology and Research, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Ajay Sharma
- Department of Medical Oncology and Research, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Saud Azam
- Department of Medical Oncology and Research, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Rashmi Shirali
- Department of Medical Oncology and Research, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| |
Collapse
|
12
|
Parikh P. Report of chronic myeloid leukemia in chronic phase from Tata Memorial Hospital, Mumbai, 2002-2008. Indian J Med Paediatr Oncol 2014; 34:164-7. [PMID: 24516299 PMCID: PMC3902614 DOI: 10.4103/0971-5851.123716] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Chronic myeloid leukemia (CML) is the commonest hematological malignancy in India. This manuscript is a single center analysis CML in chronic phase (CP). Materials and Methods: We did retrospective analysis of almost 1000 patients registered as chronic myeloid leukemia over a period of 6 years at Tata Memorial Hospital. Results: We found striking difference in cytogenetic response among patients presenting in late chronic phase (CP) compared with the patients in early CP. The rate of complete cytogenetic response among patients in late CP was 60% while in early CP it was 80%, which was statistically significant (P = 0.0001). The overall survival was 86%, at a median follow-up of 51 months. Innovator glivec was taken by 671 patients among which complete cytogenetic response (CCyR) was seen in 72% whereas generic veenat was taken by 237 patients and CCyR was seen in 75% of them. Conclusion: Availability of imatinib has dramatically changed the outlook for CML in India. The response was identical for those treated with innovator brand of imatinib as compared to the generic brand. Hence quality generics provide a cost effective solution, which is particularly relevant in the current global scenario.
Collapse
Affiliation(s)
- Purvish Parikh
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
13
|
Qin YZ, Jiang Q, Jiang H, Li JL, Li LD, Zhu HH, Lai YY, Lu XJ, Liu YR, Jiang B, Huang XJ. Which method better evaluates the molecular response in newly diagnosed chronic phase chronic myeloid leukemia patients with imatinib treatment, BCR-ABLIS or log reduction from the baseline level? Leuk Res 2013; 37:1035-40. [DOI: 10.1016/j.leukres.2013.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 05/30/2013] [Accepted: 06/01/2013] [Indexed: 11/15/2022]
|
14
|
Sociedade Brasileira de Patologia, Sociedade Brasileira de Pediatria. Leucemia mieloide crônica. Rev Assoc Med Bras (1992) 2013; 59:220-32. [DOI: 10.1016/j.ramb.2012.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 08/01/2012] [Indexed: 01/13/2023] Open
|
15
|
Francis S, Lucas C, Lane S, Wang L, Watmough S, Knight K, Bell J, Kaleel-Rahman M, Lee E, O'Brien D, Butt NM, Sadik W, De Soysa L, Seale JRC, Salim R, Clark RE. A population study showing that the advent of second generation tyrosine kinase inhibitors has improved progression-free survival in chronic myeloid leukaemia. Leuk Res 2013; 37:752-8. [PMID: 23618689 DOI: 10.1016/j.leukres.2013.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 03/12/2013] [Accepted: 04/03/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Population based data suggest the proportion of patients failing imatinib in chronic myeloid leukaemia (CML) is higher than the reported one-third of patients in clinical trials. Clinical trials have demonstrated second generation tyrosine kinase inhibitors (TKI) dasatinib and nilotinib can restore complete cytogenetic remission (CCR) and major molecular response (MMR) to many patients failing imatinib, but their impact in the general population is not clear. DESIGN AND METHODS We report CML outcome in a population of 2.3 million people in a geographically contiguous area of North West England and North Wales. RESULTS Between 2003 and 2009, 192 new CML cases were diagnosed, of whom 184 were in chronic phase and 160 started on imatinib. The maximal CCR rate was 65% at 24 months and the maximal MMR rate was 50% at 36 months. Patients diagnosed since second generation TKI became available for imatinib failure had a more rapid cumulative CCR and MMR rate and a significantly improved progression free survival (p=0.022) than those diagnosed before this time. CONCLUSION The study indicates that second generation TKI have improved CML outcome in the general population.
Collapse
Affiliation(s)
- Sebastian Francis
- Haematology Department, Royal Liverpool University Hospital, Liverpool, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
de Souza CA, Pagnano KBB, Bendit I, Conchon M, Freitas CMBDM, Coelho AM, Funke VAM, Bernardo WM. Chronic myeloid leukemia treatment guidelines: Brazilian Association of Hematology, Hemotherapy and Cell Therapy. Brazilian Medical Association Guidelines Project - 2012. Rev Bras Hematol Hemoter 2012; 34:367-82. [PMID: 23125546 PMCID: PMC3486828 DOI: 10.5581/1516-8484.20120094] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 07/13/2012] [Indexed: 01/29/2023] Open
|
17
|
Vigil CE, Griffiths EA, Wang ES, Wetzler M. Improving the Quality of Quantitative Real-Time Polymerase Chain Reaction Laboratory Reporting in Chronic Myeloid Leukemia. Lab Med 2012. [DOI: 10.1309/lmse7m60tabhdnev] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
18
|
Machado MP, Tomaz JP, Lorand-Metze I, de Souza CA, Vigorito AC, Delamain MT, Bendit I, Pereira NF, Pagnano KBB. Monitoring of BCR-ABL levels in chronic myeloid leukemia patients treated with imatinib in the chronic phase - the importance of a major molecular response. Rev Bras Hematol Hemoter 2012; 33:211-5. [PMID: 23049298 PMCID: PMC3415739 DOI: 10.5581/1516-8484.20110056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Accepted: 03/23/2011] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Real time PCR has become the most common technique to monitor BCR-ABL transcript levels of patients treated with kinase inhibitors. The aim of this study was to evaluate BCR-ABL levels of chronic myeloid leukemia patients treated with imatinib in the chronic phase and correlate the response to therapy and event-free survival. METHODS BCR-ABL levels were measured in peripheral blood cell samples using Real time PCR at diagnosis and then every 3 months after starting therapy with imatinib. Major molecular response was defined as a three-log reduction from the standardized baseline value. Major molecular response values were adjusted to international scale using a conversion factor of 1.19. The results are reported as a BCR-ABL/ABL ratio (%). RESULTS Hematological, major cytogenetic and complete cytogenetic responses were achieved by 57 (95%), 45 (75%) and 38 (63%) patients, respectively. Twenty-four out of sixty patients achieved a major molecular response (40%) in a median time of 8.5 months. Overall survival and event free survival were higher for patients with (100%) versus patients without (77%) a complete cytogenetic response (p-value = 0.01) at 48 months. Patients with complete cytogenetic response and major molecular response had a higher event free survival compared to patients with complete cytogenetic response but without major molecular response (p-value = 0.007). CONCLUSION In conclusion, the prognostic impact of achieving complete cytogenetic response and a major molecular response and also the importance of molecular monitoring in the follow-up of chronic myeloid leukemia patients were demonstrated.s.
Collapse
|
19
|
Wang L, Giannoudis A, Austin G, Clark RE. Peroxisome proliferator-activated receptor activation increases imatinib uptake and killing of chronic myeloid leukemia cells. Exp Hematol 2012; 40:811-9.e2. [PMID: 22677017 DOI: 10.1016/j.exphem.2012.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 05/08/2012] [Accepted: 05/29/2012] [Indexed: 12/13/2022]
Abstract
Low pretreatment expression of the imatinib uptake transporter human organic cation transporter 1 (hOCT1) is associated with inferior complete cytogenetic response rates, progression-free survival, and overall survival in imatinib-treated chronic myeloid leukemia (CML). Upregulation of hOCT1 can therefore increase the uptake of imatinib. The hOCT1 gene is transactivated by hepatocyte nuclear factor 4α in human liver, and peroxisome proliferator-activated receptors (PPAR) α and γ activation increases OCT1 expression in mouse hepatocytes. Here we report that no isoform of hepatocyte nuclear factor 4α is expressed in CML lines or in CML primary cells. In contrast, both PPARα and γ were expressed in all CML cell lines and primary cells studied. PPARα agonist treatment increased imatinib killing of CML KCL22 cells and primitive CD34(+) cells, and also upregulates hOCT1 gene expression and increases imatinib uptake into KCL22 cells and primary cells. PPARα agonists might potentially be of clinical use in CML patients failing imatinib.
Collapse
Affiliation(s)
- Lihui Wang
- Section of Haematology, Department of Molecular and Cancer Medicine, the University of Liverpool, Liverpool, UK
| | | | | | | |
Collapse
|
20
|
Predictive value of early molecular response in patients with chronic myeloid leukemia treated with first-line dasatinib. Blood 2012; 120:291-4. [PMID: 22645182 DOI: 10.1182/blood-2012-01-407486] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Dasatinib is effective therapy for newly diagnosed patients with chronic myeloid leukemia, but not all patients respond well. We analyzed the outcome of patients treated with dasatinib as first-line therapy to identify patients who are more likely to fare poorly. The 8.6% of patients who at 3 months had a BCR-ABL1/ABL1 ratio > 10% had a significantly worse 2-year cumulative incidence of complete cytogenetic response (58.8% vs 96.6%, P < .001) and molecular responses than the remaining patients with a lower transcript levels. The predictive value of the 3-month transcript level could be improved using the dasatinib-specific transcript level cut-offs, namely, 2.2%, 0.92%, and 0.57% for complete cytogenetic response, 3 log and 4.5 log reductions in the transcript level, respectively. The study was registered at www.clinicaltrials.gov as #NCT01460693.
Collapse
|
21
|
Lucas CM, Fagan JL, Carter A, Swale B, Evans C, Clark RE, Harris RJ. Rapid diagnosis of chronic myeloid leukemia by flow cytometric detection of BCR-ABL1 protein. Haematologica 2011; 96:1077-8. [PMID: 21546494 DOI: 10.3324/haematol.2011.043166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
22
|
Cancerous inhibitor of PP2A (CIP2A) at diagnosis of chronic myeloid leukemia is a critical determinant of disease progression. Blood 2011; 117:6660-8. [PMID: 21490338 DOI: 10.1182/blood-2010-08-304477] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Prospective identification of patients whose chronic myeloid leukemia (CML) will progress to blast crisis is currently not possible. PP2A is a phosphatase and tumor suppressor that regulates cell proliferation, differentiation, and survival. Cancerous inhibitor of PP2A (CIP2A) is a recently described inhibitor of PP2A in breast and gastric cancer. The aim of this study was to investigate whether CIP2A played a role in CML and whether PP2A or its inhibitor proteins CIP2A or SET could predict clinical outcome. At the time of diagnosis of CML, patients who will later progress to blast crisis have significantly higher levels of CIP2A protein (P < .0001) than patients who do not progress, suggesting that PP2A is functionally inactive. We show that the potential mechanism for disease progression is via altered phosphorylation of the oncogene c-Myc. Knockdown of CIP2A results in increased PP2A activity, decreased c-Myc levels, and a decrease in BCR-ABL1 tyrosine kinase activity. We demonstrate that CIP2A levels at diagnosis can consistently predict patients who will progress to blast crisis. The data show that CIP2A is biologically and clinically important in CML and may be a novel therapeutic target.
Collapse
|
23
|
Lima L, Bernal-Mizrachi L, Saxe D, Mann KP, Tighiouart M, Arellano M, Heffner L, McLemore M, Langston A, Winton E, Khoury HJ. Peripheral blood monitoring of chronic myeloid leukemia during treatment with imatinib, second-line agents, and beyond. Cancer 2010; 117:1245-52. [DOI: 10.1002/cncr.25678] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 06/28/2010] [Accepted: 08/25/2010] [Indexed: 11/11/2022]
|
24
|
High-density single nucleotide polymorphism array analysis and ASXL1 gene mutation screening in chronic myeloid leukemia during disease progression. Leukemia 2010; 24:1139-45. [PMID: 20410925 DOI: 10.1038/leu.2010.65] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We have undertaken a genome-wide single nucleotide polymorphism (SNP) array analysis of 41 chronic myeloid leukemia (CML) patients. In total, 44 regions of uniparental disomy (UPD) >3 Mb were identified in 24 of 32 patients in chronic phase (CP), and 21 regions of UPD >3 Mb were identified in 13 of 21 patients in blast crisis (BC). Chromosome 8 had the highest frequency of UPD regions in both CP and BC samples. Eight recurrent regions of UPD were observed among the 41 patients, with chromosome 8 showing the highest frequency. Ten regions of copy number change (CNC) >3 Mb were observed in 4 of 21 patients in BC, whereas none were observed in CP. We have identified several recurrent regions of UPD and CNC in CML that may be of pathogenetic importance. Overrepresentation of genomic aberrations (UPD and copy number gain) mapping to chromosome 8 was observed. Selected candidate genes mapping within the aberrant genomic regions were sequenced and mutation of the TP53 gene was observed in one case in BC and of the ASXL1 gene in 6 of 41 cases in CP or BC. Mutation of ASXL1 represents an important new molecular abnormality in CML.
Collapse
|
25
|
The use of imatinib mesylate as a lifesaving treatment of chronic myeloid leukemia relapse after bone marrow transplantation. J Transplant 2009; 2009:357093. [PMID: 20107580 PMCID: PMC2809434 DOI: 10.1155/2009/357093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Accepted: 08/14/2009] [Indexed: 01/19/2023] Open
Abstract
We describe the
response of imatinib as lifesaving treatment of
chronic myeloid leukemia (CML) relapse in seven
patients who underwent allogeneic bone marrow
transplantation (alloBMT) at our institution
over a period of 4 years. Retrospective analysis
of their medical records revealed that a mean age at
transplant was 45.2 years. The median time to
diagnosis was 7.4 years after transplant. At
relapse, four, two, and one patients were
classified as having hematologic, major
molecular, and cytogenetic relapse, respectively.
At imatinib initiation, five had CML in a
chronic phase, while one patient was
diagnosed as having accelerated phase and blast
crisis. All these patients could be evaluated
for the therapeutic efficacy. At a mean of
follow-up of 1.9 years of therapy, all evaluable
patients achieved major molecular response
without compromising safety. Consistent with
available data, our results indicate that
imatinib is safe and effective treatment option
for patients with relapse after
BMT.
Collapse
|
26
|
Jevremovic D, Viswanatha DS. Molecular diagnosis of hematopoietic and lymphoid neoplasms. Hematol Oncol Clin North Am 2009; 23:903-33. [PMID: 19577174 DOI: 10.1016/j.hoc.2009.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This chapter summarizes the significance and molecular diagnostic detection of genetic abnormalities commonly associated with hematolymphoid neoplasms. Methodologic aspects of laboratory diagnosis are presented, as well as discussion of multiparameter genotyping of tumors for prognosis and the role of minimal residual disease monitoring in specific neoplasms.
Collapse
Affiliation(s)
- Dragan Jevremovic
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | | |
Collapse
|
27
|
Lucas CM, Harris RJ, Giannoudis A, Davies A, Knight K, Watmough SJ, Wang L, Clark RE. Chronic myeloid leukemia patients with the e13a2 BCR-ABL fusion transcript have inferior responses to imatinib compared to patients with the e14a2 transcript. Haematologica 2009; 94:1362-7. [PMID: 19713230 DOI: 10.3324/haematol.2009.009134] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Chronic myeloid leukemia is characterized by a reciprocal translocation between chromosomes 9 and 22, creating the fusion gene BCR-ABL. The clinical significance of the type of BCR-ABL transcript in newly diagnosed patients in chronic phase treated with imatinib 400 mg from initial diagnosis remains unknown. DESIGN AND METHODS We analyzed the clinical outcome of 78 newly diagnosed chronic phase patients, aged 16 or over, treated with imatinib 400 mg. Of these, 71 expressed either e13a2 or e14a2 transcripts. BCR-ABL transcripts were assayed by quantitative real-time polymerase chain reaction. RESULTS After 12 months of treatment, 54% of the e14a2 patients had achieved a complete cytogenetic response, compared to 25% of the e13a2 patients (p=0.01). Kaplan-Meier analysis of the time to achieve complete cytogenetic response revealed that e14a2 patients had more rapid response rates, compared to e13a2 patients (p=0.006). e14a2 patients had a higher event-free survival rate in the first 12 months of treatment, although overall survival did not differ significantly between the patients with the two types of transcript. Human organic cation transporter protein 1 mRNA levels did not differ between the patients with the two types of transcript. The pre-treatment pCrKL/CrKL ratio (a surrogate marker of BCR-ABL tyrosine kinase activity) was higher in patients with e13a2 transcripts than in those with e14a2 (p=0.017). CONCLUSIONS Patients expressing the e14a2 transcript type have a higher rate and more rapid complete cytogenetic responses than e13a2-expressing patients, which may be due to higher BCR-ABL tyrosine kinase activity. Knowledge of the transcript type may yield additional prognostic information, although this requires testing on larger datasets.
Collapse
Affiliation(s)
- Claire M Lucas
- Department of Haematology, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Sohn SK, Moon JH, Cho YY, Chae YS, Kim JG, Lee KS, Hong SP, Kim SO. Efficacy of dose escalation of imatinib mesylate in patients with cytogenetic or hematologic resistance. Leuk Lymphoma 2009; 48:1659-61. [PMID: 17701605 DOI: 10.1080/10428190701474381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
MESH Headings
- Adult
- Aged
- Antineoplastic Agents/administration & dosage
- Benzamides
- Drug Resistance, Neoplasm
- Female
- Humans
- Imatinib Mesylate
- Karyotyping
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Male
- Middle Aged
- Piperazines/administration & dosage
- Pyrimidines/administration & dosage
- Retrospective Studies
- Survival Rate
- Treatment Outcome
Collapse
|
29
|
Neumann F, Markett J, Fenk R, Pooten M, Koch A, Bruennert D, Schimkus N, Wulfert M, Royer-Pokora B, Kronenwett R, Haas R, Gattermann N. Therapy adapted to molecular response in patients with chronic myelogenous leukaemia in first chronic phase: results of the Duesseldorf study. Hematol Oncol 2008; 26:213-8. [DOI: 10.1002/hon.860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
30
|
Desirable performance characteristics for BCR-ABL measurement on an international reporting scale to allow consistent interpretation of individual patient response and comparison of response rates between clinical trials. Blood 2008; 112:3330-8. [DOI: 10.1182/blood-2008-04-150680] [Citation(s) in RCA: 312] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractAn international basis for comparison of BCR-ABL mRNA levels is required for the common interpretation of data derived from individual laboratories. This will aid clinical decisions for individual patients with chronic myeloid leukemia (CML) and assist interpretation of results from clinical studies. We aligned BCR-ABL values generated by 38 laboratories to an international scale (IS) where a major molecular response (MMR) is 0.1% or less. Alignment was achieved by application of laboratory-specific conversion factors calculated by comparisons performed with patient samples against a reference method. A validation procedure was completed for 19 methods. We determined performance characteristics (bias and precision) for consistent interpretation of MMR after IS conversion. When methods achieved an average BCR-ABL difference of plus or minus 1.2-fold from the reference method and 95% limits of agreement within plus or minus 5-fold, the MMR concordance was 91%. These criteria were met by 58% of methods. When not met, the MMR concordance was 74% or less. However, irrespective of precision, when the bias was plus or minus 1.2-fold as achieved by 89% of methods, there was good agreement between the overall MMR rates. This indicates that the IS can deliver accurate comparison of molecular response rates between clinical trials when measured by different laboratories.
Collapse
|
31
|
Lucas CM, Wang L, Austin GM, Knight K, Watmough SJ, Shwe KH, Dasgupta R, Butt NM, Galvani D, Hoyle CF, Seale JRC, Clark RE. A population study of imatinib in chronic myeloid leukaemia demonstrates lower efficacy than in clinical trials. Leukemia 2008; 22:1963-6. [PMID: 18754023 DOI: 10.1038/leu.2008.225] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
32
|
Ross DM, Watkins DB, Hughes TP, Branford S. Reverse transcription with random pentadecamer primers improves the detection limit of a quantitative PCR assay for BCR-ABL transcripts in chronic myeloid leukemia: implications for defining sensitivity in minimal residual disease. Clin Chem 2008; 54:1568-71. [PMID: 18641042 DOI: 10.1373/clinchem.2008.105916] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Real-time quantitative reverse transcription PCR (RQ-PCR) assay for BCR-ABL is used to monitor treatment response in chronic myeloid leukemia (CML). BCR-ABL transcript levels decline over several years of imatinib treatment, and increasing numbers of patients have BCR-ABL transcripts at or below the limit of detection. More sensitive PCR methods are required to assess whether these patients have a long-term continuing decline in residual disease. METHODS We used random pentadecamer (R15) primers for reverse transcription in RQ-PCR and compared the results with our established method that uses random hexamers. An increase in assay sensitivity would be detected as an increase in the number of BCR-ABL transcripts. RESULTS BCR-ABL transcripts increased by 86% with R15 primers. We used R15 primers to retest 19 samples from selected CML patients who had no BCR-ABL transcripts recently detectable with hexamer primers and detected BCR-ABL transcripts in 68% of the samples. Use of R15 primers showed variable increases in the transcripts for control genes BCR (breakpoint cluster region), ABL1 (c-abl oncogene 1, receptor tyrosine kinase), and GUSB (glucuronidase, beta), depending on the gene examined. The reported BCR-ABL/control gene ratio was affected, and the estimated detection limit of the assay, which was based on increased control gene copy number, was different for each control gene. CONCLUSIONS This simple modification to the reverse transcription methodology improved the detection limit of the RQ-PCR assay for BCR-ABL transcripts. In the field of CML, these results have important implications for defining the detection limit of an assay when the BCR-ABL transcript is undetectable. Random pentadecamer primers may also be useful in other reverse transcription PCR assays for which the abundance of the target RNA is low.
Collapse
Affiliation(s)
- David M Ross
- Division of Haematology, Institute of Medical & Veterinary Science, Adelaide, Australia.
| | | | | | | |
Collapse
|
33
|
Quantitative detection of bcr-abl transcripts in chronic myeloid leukemia. ACTA ACUST UNITED AC 2008; 57:388-91. [PMID: 18387753 DOI: 10.1016/j.patbio.2007.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Accepted: 12/14/2007] [Indexed: 11/23/2022]
Abstract
The optimal management of malignant haematological disorders depend on the degree of tumor load reduction after therapy. Chronic myeloid leukemia constitutes a clinical model for molecular detection and therapy surveillance of malignant disease since this entity was the first leukemia shown to be associated with a specific bcr-abl fusion gene in the patient's leukemia cells. Molecular monitoring of bcr-abl transcript levels by real-time quantitative PCR is increasingly used to assess treatment response in patients with chronic myeloid leukemia (CML). This has become particularly relevant in the era of imatinib therapy when residual levels of leukaemia usually fall below the level of detection by bone marrow cytogenetic analysis. We monitored bcr-abl transcript levels by quantitative real time PCR in 50 tunisian patients treated with imatinib for chronic myeloid leukemia in chronic phase for a median of 29 months (3-60) after they started imatinib.
Collapse
|
34
|
Ross D, Hughes T. Current and emerging tests for the laboratory monitoring of chronic myeloid leukaemia and related disorders. Pathology 2008; 40:231-46. [DOI: 10.1080/00313020801916172] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
35
|
Monitoring minimal residual disease in patients with chronic myeloid leukemia after treatment with tyrosine kinase inhibitors. Curr Opin Hematol 2008; 15:134-9. [DOI: 10.1097/moh.0b013e3282f42898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
36
|
Monitoring the response and course of chronic myeloid leukemia in the modern era of BCR-ABL tyrosine kinase inhibitors: practical advice on the use and interpretation of monitoring methods. Blood 2008; 111:1774-80. [PMID: 18055868 DOI: 10.1182/blood-2007-09-110189] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
37
|
Rojas JM, Knight K, Wang L, Clark RE. Clinical evaluation of BCR-ABL peptide immunisation in chronic myeloid leukaemia: results of the EPIC study. Leukemia 2007; 21:2287-95. [PMID: 17637811 DOI: 10.1038/sj.leu.2404858] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Peptides from the e14a2 BCR-ABL junction will elicit T-cell responses in vitro. Here, 19 imatinib treated CML patients in first chronic phase were vaccinated with BCR-ABL peptides spanning the e14a2 fusion junction, some of which were linked to the pan DR epitope PADRE to augment CD4+ T cell help. Six vaccinations were given over 9 weeks, together with sargramostim. All patients developed mild local reactions. T cell responses to PADRE were seen in all patients. Fourteen of 19 patients developed T cell responses to BCR-ABL peptides. The development of an anti-BCR-ABL T cell response correlated with a subsequent fall in BCR-ABL transcripts. No molecular benefit was seen in the 5 patients not in major cytogenetic response (MCR) at baseline. However, of the 14 patients in MCR at baseline, 13 developed at least 1 log fall in BCR-ABL transcripts, though this occurred several months after completing vaccination, consistent with an effect at a primitive CML stem cell level. Vaccination may improve the fall in BCR-ABL transcripts in patients who have received imatinib for more than 12 months. BCR-ABL peptide vaccination may improve control of CML, especially in patients responding well to imatinib. Randomised trials are required to address this further.
Collapse
Affiliation(s)
- J M Rojas
- Department of Haematology, University of Liverpool, Liverpool, UK
| | | | | | | |
Collapse
|
38
|
Wang L, Giannoudis A, Lane S, Williamson P, Pirmohamed M, Clark RE. Expression of the uptake drug transporter hOCT1 is an important clinical determinant of the response to imatinib in chronic myeloid leukemia. Clin Pharmacol Ther 2007; 83:258-64. [PMID: 17568400 DOI: 10.1038/sj.clpt.6100268] [Citation(s) in RCA: 199] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Some chronic myeloid leukemia (CML) patients do not respond to imatinib, whereas others lose an initial response. To identify potential imatinib failures, we investigated the expression of imatinib uptake transporter (human organic cation transporter 1; hOCT1) and efflux transporters (ATP-binding cassette transporters ABCB1, ABCG2, and ABCC1) using real-time quantitative reverse transcription-polymerase chain reaction in 70 CML patients. Patients with high pretreatment hOCT1 expression had superior complete cytogenetic response (CCR) rates (P=0.008), progression-free and overall survival (P=0.01 and 0.004). Pretreatment ABCB1, ABCG2, and ABCC1 levels did not correlate with treatment outcome. Regression analysis demonstrated that pretreatment hOCT1 expression was the most powerful predictor of CCR achievement at 6 months (P=0.002). Imatinib uptake into a CML cell line with high hOCT1 expression was greater than into those with modest or low expression (P=0.002). The expression of hOCT1, but not efflux transporters, is important in determining the clinical response to imatinib.
Collapse
MESH Headings
- ATP Binding Cassette Transporter, Subfamily B
- ATP Binding Cassette Transporter, Subfamily B, Member 1/genetics
- ATP Binding Cassette Transporter, Subfamily B, Member 1/metabolism
- ATP Binding Cassette Transporter, Subfamily G, Member 1
- ATP Binding Cassette Transporter, Subfamily G, Member 2
- ATP-Binding Cassette Transporters/genetics
- ATP-Binding Cassette Transporters/metabolism
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/metabolism
- Antineoplastic Agents/therapeutic use
- Benzamides
- Cell Line, Tumor
- Disease-Free Survival
- Fusion Proteins, bcr-abl
- Gene Expression Regulation, Neoplastic
- Humans
- Imatinib Mesylate
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/metabolism
- Middle Aged
- Mutation
- Neoplasm Proteins/genetics
- Neoplasm Proteins/metabolism
- Octamer Transcription Factor-1/genetics
- Octamer Transcription Factor-1/metabolism
- Patient Selection
- Piperazines/metabolism
- Piperazines/therapeutic use
- Protein Kinase Inhibitors/metabolism
- Protein Kinase Inhibitors/therapeutic use
- Protein-Tyrosine Kinases/genetics
- Protein-Tyrosine Kinases/metabolism
- Pyrimidines/metabolism
- Pyrimidines/therapeutic use
- Regression Analysis
- Reverse Transcriptase Polymerase Chain Reaction
- Time Factors
- Transfection
- Treatment Outcome
Collapse
Affiliation(s)
- L Wang
- University Department of Haematology, Royal Liverpool University Hospital, Liverpool, UK
| | | | | | | | | | | |
Collapse
|
39
|
Abstract
Imatinib (Gleevec, Glivec) is a synthetic tyrosine kinase inhibitor used in the treatment of chronic myeloid leukaemia (CML). It is specifically designed to inhibit the breakpoint cluster region (BCR)-Abelson (ABL) fusion protein that results from the chromosomal abnormality known as the Philadelphia chromosome. CML is characterised by this abnormality, which leads to abnormalities of the peripheral blood and bone marrow including an increase in the number of granular leukocytes. Imatinib is approved in numerous countries worldwide for the treatment of newly diagnosed Philadelphia chromosome-positive (Ph+) chronic-phase CML, Ph+ accelerated-phase or blast-crisis CML, and in patients with Ph+ chronic-phase CML who have failed to respond to interferon-alpha therapy. It is also indicated in paediatric patients with newly diagnosed Ph+ chronic-phase CML, in accelerated-phase or blast-crisis CML, or in chronic-phase CML after failure of interferon-alpha therapy or when the disease has recurred after haematopoietic stem cell transplantation (HSCT). Approved indications, however, may vary by country. Imatinib is effective and generally well tolerated in patients with Ph+ CML. In patients with newly diagnosed chronic-phase CML, imatinib was more effective than interferon-alpha plus cytarabine in preventing progression of the disease and in achieving haematological and cytogenetic responses. Overall survival rates remain high after 5 years of follow-up, and historical comparisons with other treatments demonstrate improved overall survival with imatinib in the long term. Patients with accelerated-phase or blast-crisis CML, or those who have not responded to prior interferon-alpha therapy also benefit from imatinib treatment. Some patients become resistant or intolerant to imatinib therapy; management strategies to overcome these problems include dosage adjustment, other treatments, or combination therapy with imatinib and other agents. Allogeneic HSCT is currently the only potentially curative treatment, but it is associated with high rates of morbidity and mortality and is not suitable for all patients. The introduction of imatinib has had a marked impact on outcomes in patients with CML. It remains a valuable treatment for all stages of the disease, especially initial treatment of newly diagnosed Ph+ chronic-phase CML, and is endorsed by European and US treatment guidelines as a first-line option.
Collapse
Affiliation(s)
- Marit D Moen
- Wolters Kluwer Health, Adis, Auckland, New Zealand
| | | | | | | |
Collapse
|
40
|
Liu YC, Hsiao HH, Chang JG, Yang MY, Liu TC, Chang CS, Tseng SB, Tsai HJ, Lin SF. Usefulness of quantitative assessment of JunB gene expression as a marker for monitoring chronic myeloid leukemia patients undergoing imatinib therapy. Int J Hematol 2007; 84:425-31. [PMID: 17189224 DOI: 10.1532/ijh97.a10514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
JunB is a component of the activator protein 1 transcription factors and has been identified to be important in hematopoiesis. Transgenic mice lacking JunB expression develop myeloproliferative disease resembling human chronic myeloid leukemia (CML). JunB expression was significantly decreased in CML patients. We used real-time quantitative reverse transcription-polymerase chain reaction analysis to monitor both JunB and BCR-ABL expression during imatinib therapy. Nineteen patients were evaluated every 2 to 4 weeks, and their levels of JunB expression before therapy were significantly decreased compared with those of healthy individuals. After imatinib therapy, an increase in JunB expression was found in 5 patients, all of whom achieved a complete cytogenetic response (CCR) and molecular response (MR), with a decrease in BCR-ABL expression. JunB expression decreased to a very low level in 2 patients, both of whom showed progression to blast crisis. Variable JunB expression was found in the other 12 patients, and their outcomes were mostly driven by BCR-ABL levels. The patients with an increase in JunB expression were statistically more likely to achieve a major cytogenetic response (P = .045), CCR (P = .033), and MR (P = .033) than the group with no increase in JunB expression, and a durable response was observed. This study revealed that an increase in JunB expression is a good prognostic marker for predicting clinical response in CML patients treated with imatinib when such data are combined with an evaluation of BCR-ABL expression.
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Antineoplastic Agents/administration & dosage
- Benzamides
- Biomarkers, Tumor/biosynthesis
- Biomarkers, Tumor/genetics
- Female
- Fusion Proteins, bcr-abl/biosynthesis
- Fusion Proteins, bcr-abl/genetics
- Gene Expression Regulation, Leukemic
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Male
- Middle Aged
- Monitoring, Physiologic
- Piperazines/administration & dosage
- Predictive Value of Tests
- Proto-Oncogene Proteins c-jun/biosynthesis
- Proto-Oncogene Proteins c-jun/genetics
- Pyrimidines/administration & dosage
- Reverse Transcriptase Polymerase Chain Reaction
- Treatment Outcome
Collapse
Affiliation(s)
- Yi-Chang Liu
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Branford S, Cross NCP, Hochhaus A, Radich J, Saglio G, Kaeda J, Goldman J, Hughes T. Rationale for the recommendations for harmonizing current methodology for detecting BCR-ABL transcripts in patients with chronic myeloid leukaemia. Leukemia 2006; 20:1925-30. [PMID: 16990771 DOI: 10.1038/sj.leu.2404388] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Molecular monitoring for patients with chronic myeloid leukaemia (CML) has become an important practice in the era of imatinib therapy. For successful widespread introduction into the mainstream patient monitoring schedule, many procedural aspects of the complex real-time quantitative polymerase chain reaction (RQ-PCR) technique for measuring BCR-ABL transcripts require optimization. Recommendations for harmonizing the differing methodologies have recently been proposed. These recommendations were designed to maximize reliability of analysis for clinical decision making and proposed the adoption of an International Scale of measurement. The purpose of this review is to present the evidence and supporting data for specific recommendations. These recommendations include use of the same source of cells, either blood or marrow, for analysis; for validation of equal PCR amplification efficiencies of cDNA and standards when using a plasmid to construct standard curves and for ensuring ongoing high-level performance by undertaking a quality assurance programme. Clinicians must know the measurement reliability of an RQ-PCR assay to be able to determine the significance of a change in BCR-ABL level. An assay with poor precision limits the clinical usefulness of results. International harmonization should establish RQ-PCR measurement of BCR-ABL as the best method for monitoring treatment response for patients with CML.
Collapse
Affiliation(s)
- S Branford
- Division of Molecular Pathology, Institute of Medical and Veterinary Science, Adelaide, South Australia.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Hughes T, Deininger M, Hochhaus A, Branford S, Radich J, Kaeda J, Baccarani M, Cortes J, Cross NCP, Druker BJ, Gabert J, Grimwade D, Hehlmann R, Kamel-Reid S, Lipton JH, Longtine J, Martinelli G, Saglio G, Soverini S, Stock W, Goldman JM. Monitoring CML patients responding to treatment with tyrosine kinase inhibitors: review and recommendations for harmonizing current methodology for detecting BCR-ABL transcripts and kinase domain mutations and for expressing results. Blood 2006; 108:28-37. [PMID: 16522812 PMCID: PMC1895821 DOI: 10.1182/blood-2006-01-0092] [Citation(s) in RCA: 863] [Impact Index Per Article: 47.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Accepted: 02/18/2006] [Indexed: 01/14/2023] Open
Abstract
The introduction in 1998 of imatinib mesylate (IM) revolutionized management of patients with chronic myeloid leukemia (CML) and the second generation of tyrosine kinase inhibitors may prove superior to IM. Real-time quantitative polymerase chain reaction (RQ-PCR) provides an accurate measure of the total leukemiacell mass and the degree to which BCR-ABL transcripts are reduced by therapy correlates with progression-free survival. Because a rising level of BCR-ABL is an early indication of loss of response and thus the need to reassess therapeutic strategy, regular molecular monitoring of individual patients is clearly desirable. Here we summarize the results of a consensus meeting that took place at the National Institutes of Health (NIH) in Bethesda in October 2005. We make suggestions for (1) harmonizing the differing methodologies for measuring BCR-ABL transcripts in patients with CML undergoing treatment and using a conversion factor whereby individual laboratories can express BCR-ABL transcript levels on an internationally agreed scale; (2) using serial RQ-PCR results rather than bone marrow cytogenetics or fluorescence in situ hybridization (FISH) for the BCR-ABL gene to monitor individual patients responding to treatment; and (3) detecting and reporting Philadelphia (Ph) chromosome-positive subpopulations bearing BCR-ABL kinase domain mutations. We recognize that our recommendations are provisional and will require revision as new evidence emerges.
Collapse
MESH Headings
- Drug Monitoring/methods
- Fusion Proteins, bcr-abl/genetics
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Mutation
- Protein Kinase Inhibitors/therapeutic use
- Protein Structure, Tertiary/genetics
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Protein-Tyrosine Kinases/genetics
- Reverse Transcriptase Polymerase Chain Reaction/methods
- Reverse Transcriptase Polymerase Chain Reaction/standards
- Sensitivity and Specificity
Collapse
Affiliation(s)
- Timothy Hughes
- Institute of Medical and Veterinary Science, Adelaide, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Martinelli G, Iacobucci I, Rosti G, Pane F, Amabile M, Castagnetti F, Cilloni D, Soverini S, Testoni N, Specchia G, Merante S, Zaccaria A, Frassoni F, Saglio G, Baccarani M. Prediction of response to imatinib by prospective quantitation of BCR-ABL transcript in late chronic phase chronic myeloid leukemia patients. Ann Oncol 2006; 17:495-502. [PMID: 16403813 DOI: 10.1093/annonc/mdj106] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Imatinib mesylate (STI571), a specific Bcr-Abl inhibitor, has shown a potent antileukemic activity in clinical studies of chronic myeloid leukemia (CML) patients. Early prediction of response to imatinib cannot be anticipated. We used a standardized quantitative reverse-transcriptase polymerase chain reaction (QRT-PCR) for BCR-ABL transcripts on 191 out of 200 late-chronic phase CML patients enrolled in a phase II clinical trial with imatinib 400 mg/day. Bone marrow samples were collected before treatment, after 12, 20 and at the end of study treatment (52 weeks) while peripheral blood samples were obtained after 2, 3, 6, 10, 14, 20 and 52 weeks of therapy. The amount of BCR-ABL transcript was expressed as the ratio of BCR-ABL to beta2-microglobulin (beta2M). We show that, following initiation of imatinib, the early BCR-ABL level trends in both bone marrow and peripheral blood samples made it possible to predict the subsequent cytogenetic outcome and response. We propose this method as the method of choice for monitoring patients on imatinib therapy. QRT-PCR studies may be able to identify degrees of molecular response that predict both complete cytogenetic response and long term stability, as well as patterns of response that provide an early indication of relapse and imatinib resistance.
Collapse
Affiliation(s)
- G Martinelli
- Institute of Hematology and Medical Oncology L. and A. Seràgnoli, University of Bologna, Bologna, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Ross DM, Branford S, Moore S, Hughes TP. Limited clinical value of regular bone marrow cytogenetic analysis in imatinib-treated chronic phase CML patients monitored by RQ-PCR for BCR-ABL. Leukemia 2006; 20:664-70. [PMID: 16482210 DOI: 10.1038/sj.leu.2404139] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Real-time quantitative polymerase chain reaction (PCR) for BCR-ABL mRNA in the peripheral blood (RQ-PCR) provides an accurate and reliable measure of response to therapy in chronic myeloid leukaemia (CML). We wanted to determine in what circumstances additional clinically relevant information was provided by simultaneous cytogenetic analysis in RQ-PCR monitored patients receiving imatinib treatment. We analysed 828 simultaneous RQ-PCR and bone marrow cytogenetic analyses from 183 patients with chronic phase CML with a median follow-up of 20 months. Cytogenetic progression was defined as Philadelphia (Ph)-positive clonal evolution, loss of complete cytogenetic response or an increase of > or = 20% Ph-positive cells. Cytogenetic progression occurred in 24/183 (13%) patients. At the time of cytogenetic progression, none of the 24 patients had a major molecular response (MMR; > or = 3-log reduction in BCR-ABL from standardised baseline). There were 320 RQ-PCR results from 95 patients indicating MMR. No abnormality was detected in any of the corresponding cytogenetic analyses. A policy of regular RQ-PCR monitoring with cytogenetic analysis targetted only to patients who have not achieved, or have lost MMR would represent a rational approach to monitoring and spare most patients the discomfort of multiple marrow aspirates. This approach depends upon availability of an accurate, reproducible RQ-PCR assay with ongoing quality assurance.
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Benzamides
- Bone Marrow/pathology
- Chromosome Aberrations
- Cloning, Molecular
- Cytogenetic Analysis/methods
- Disease Progression
- Female
- Follow-Up Studies
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Male
- Middle Aged
- Piperazines/therapeutic use
- Predictive Value of Tests
- Pyrimidines/therapeutic use
- RNA, Messenger/analysis
- Reproducibility of Results
- Retrospective Studies
- Reverse Transcriptase Polymerase Chain Reaction/methods
- Sensitivity and Specificity
- Treatment Outcome
Collapse
Affiliation(s)
- D M Ross
- Division of Haematology, Institute of Medical & Veterinary Science, Adelaide, Australia.
| | | | | | | |
Collapse
|
45
|
Levine RL, Wernig G. Role of JAK-STAT Signaling in the Pathogenesis of Myeloproliferative Disorders. Hematology 2006:233-9, 510. [PMID: 17124066 DOI: 10.1182/asheducation-2006.1.233] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The identification of JAK2V617F mutations in polycythemia vera (PV), essential thrombocytosis (ET), and myelofibrosis (MF) represents an important advance in our understanding of these myeloproliferative disorders (MPD). Most, if not all, patients with PV and a significant number of patients with ET and MF are JAK2V617F positive, and the mutation likely arises in the hematopoietic stem cell compartment. JAK2V617F is a constitutively active tyrosine kinase that is able to activate JAK-STAT signaling most efficiently when co-expressed with the erythropoietin receptor (EPOR), the thrombopoietin receptor (MPL), or the granulocyte colony-stimulating factor receptor (GCSFR). Data from murine models supports the central role of JAK2V617F in the pathogenesis of MPD, as expression of JAK2V617F in a bone marrow transplantation assay results in polycythemia and myelofibrosis in recipient mice. Activation of JAK-STAT signaling by JAK2V617F in some, but not all MPD patients with ET and MF led to the identification of the constitutively active MPLW515L allele in ET and MF. Small molecule inhibitors of JAK-STAT signaling are currently being developed, which offer potential for molecularly targeted therapy for patients with PV, ET, and MF. Despite these advances, many questions remain regarding the role of a single disease allele in three phenotypically distinct MPD, the potential clinical efficacy of JAK2 inhibitors, and the identity of oncogenic alleles in JAK2V617F/MPLW515-negative MPD.
Collapse
Affiliation(s)
- Ross L Levine
- Department of Medical Oncology, Dana-Farber Cancer Institute, 44 Binney Street D1B30, Boston, MA 02115, USA.
| | | |
Collapse
|
46
|
Hess G, Bunjes D, Siegert W, Schwerdtfeger R, Ledderose G, Wassmann B, Kobbe G, Bornhäuser M, Hochhaus A, Ullmann AJ, Kindler T, Haus U, Gschaidmeier H, Huber C, Fischer T. Sustained complete molecular remissions after treatment with imatinib-mesylate in patients with failure after allogeneic stem cell transplantation for chronic myelogenous leukemia: results of a prospective phase II open-label multicenter study. J Clin Oncol 2005; 23:7583-93. [PMID: 16234522 DOI: 10.1200/jco.2005.01.3110] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In the era of molecular therapy of chronic myelogenous leukemia (CML) applying BCR-ABL tyrosine kinase inhibitors, the usefulness of molecular end points, in particular, quantitative polymerase chain reaction (PCR) for BCR-ABL in monitoring responses has been broadly accepted. Therefore, we have designed a prospective phase II trial in CML, which, for the first time, evaluated the feasibility and safety of molecular end points as surrogate markers to guide through a stratified treatment algorithm within a multicenter trial. PATIENTS AND METHODS As a clinical model, we adopted minimal residual disease (MRD) found in relapse after allogeneic stem cell transplantation (SCT) in CML. Forty-four patients were enrolled and received the BCR-ABL tyrosine kinase inhibitor imatinib (IM) at a starting dose of 400 mg/d. The quality of molecular responses achieved then decided on discontinuation of IM or dose escalation up to 800 mg/d, and finally, on application of donor lymphocyte infusions. Results Seventy percent of patients achieved a complete molecular response (CMR), defined as nested PCR-negativity for BCR-ABL in three consecutive samples. Interestingly, in four out of 10 patients who discontinued IM, CMR was durable even after cessation of IM with a median follow-up of 494 days. This suggests the possibility of long-term tumor control in a subset of patients. CONCLUSION The treatment strategy showed that IM treatment was well-tolerated and highly efficacious in MRD after allogeneic SCT. Moreover, this study demonstrated that evaluation of a molecular end point within a multicenter trial can be a safe and effective tool for clinical decision making.
Collapse
Affiliation(s)
- Georg Hess
- III. Med. Klinik, Johannes Gutenberg-University, Mainz; University of Ulm, II. Med. Klinik, Charité, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Kim YJ, Kim DW, Lee S, Min CK, Goh HG, Kim SH, Lee JY, Kim YL, Kim HJ, Kim HJ, Lee JW, Kim TG, Min WS, Kim CC. Early prediction of molecular remission by monitoring BCR-ABL transcript levels in patients achieving a complete cytogenetic response after imatinib therapy for posttransplantation chronic myelogenous leukemia relapse. Biol Blood Marrow Transplant 2005; 10:718-25. [PMID: 15389438 DOI: 10.1016/j.bbmt.2004.06.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Imatinib induces a high complete cytogenetic response (CCR) rate in relapsed chronic myelogenous leukemia. By analyzing minimal residual disease (MRD) under the levels of CCR, we tried to assess the molecular response after imatinib therapy. By using real-time quantitative reverse transcriptase-polymerase chain reaction (Q-RT-PCR), MRD was evaluated in 23 patients (3 in cytogenetic relapse, 6 in chronic phase, 9 in accelerated phase, and 5 in blast crisis) who were treated with standard-dose imatinib for relapsed chronic myelogenous leukemia after allogeneic stem cell transplantation. With a median therapy time of 399 days (range, 35-817 days), 19 (83%) patients achieved a CCR. Meanwhile, 11 (58%) of them achieved a molecular remission (MR), which was associated with improved survival. The Q-RT-PCR data were compared according to the best response (MR, n = 11; CCR, n = 8) in the patients achieving a CCR. The BCR-ABL/ABL ratios were similar in 2 groups at 3 months but were significantly different at 6 months (median, 0.0000012 for MR and 0.00022 for CCR; P =.003). The probability of a subsequent MR was significantly higher in patients with a lower BCR-ABL/ABL ratio at 6 months (100% for <0.0001 versus 33% for >/=0.0001; P =.006) or a greater reduction in the level between 3 and 6 months (log-reduction >/=1.0;, 100%; <1.0, 17%; P =.003). Q-RT-PCR is a reliable method for monitoring MRD: the early trends in the BCR-ABL/ABL ratio may be clinically useful in discriminating patients who will achieve an MR from those who will remain in CCR.
Collapse
Affiliation(s)
- Yoo-Jin Kim
- Catholic Hematopoietic Stem Cell Transplantation Center, Catholic University of Korea, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Hughes T, Branford S. Molecular monitoring of BCR-ABL as a guide to clinical management in chronic myeloid leukaemia. Blood Rev 2005; 20:29-41. [PMID: 16426942 DOI: 10.1016/j.blre.2005.01.008] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Molecular monitoring of BCR-ABL transcript levels by real-time quantitative PCR is increasingly used to assess treatment response in patients with chronic myeloid leukaemia (CML). This has become particularly relevant in the era of imatinib therapy when residual levels of leukaemia usually fall below the level of detection by bone marrow cytogenetic analysis. Studies of imatinib-treated patients have determined that BCR-ABL levels measured early in therapy can predict subsequent response and the probability of acquired resistance. The defining of a molecular level of response that indicates a high probability of progression-free survival highlights the relevance of molecular analysis for clinical management. Small increases in the BCR-ABL level can identify patients with kinase domain mutations that lead to imatinib resistance. Therefore, these assays can be used as a screening strategy for mutation analysis. As second generation kinase inhibitors commence clinical trials, the molecular response will be a primary end-point that determines efficacy.
Collapse
MESH Headings
- Antineoplastic Agents/therapeutic use
- Benzamides
- Biomarkers/blood
- Fusion Proteins, bcr-abl/blood
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Piperazines/therapeutic use
- Pyrimidines/therapeutic use
Collapse
Affiliation(s)
- Timothy Hughes
- Institute of Medical and Veterinary Science, Frome Road, Adelaide, 5000 SA, Australia.
| | | |
Collapse
|
49
|
Mundle S, Noskina Y. Cytogenetic testing for therapeutic indication in cancer. Expert Rev Mol Diagn 2005; 5:23-9. [PMID: 15723589 DOI: 10.1586/14737159.5.1.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The association of cytogenetic abnormalities with cancer is well established. However, due to the historic lack of specific insight into the functional role of these anomalies, they have mostly served as diagnostic and/or prognostic indicators. Recent developments in chronic myelogenous leukemia and breast cancer have raised hopes for specific cytogenetic alterations to serve as therapeutic targets. This article reviews the aid provided by molecular diagnostics in these exciting developments in the cancer arena.
Collapse
MESH Headings
- Breast Neoplasms/diagnosis
- Breast Neoplasms/genetics
- Breast Neoplasms/therapy
- Chromosome Aberrations
- Cytogenetic Analysis
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
Collapse
Affiliation(s)
- Suneel Mundle
- Rush University Medical Center, Department of Biochemistry, Naperville, Chicago, IL 60565, USA.
| | | |
Collapse
|
50
|
Bolufer P, Colomer D, Gomez MT, Martínez J, Gonzalez SM, Gonzalez M, Nomdedeu J, Bellosillo B, Barragán E, Lo-Coco F, Diverio D, Hermosin L, García-Marco J, De Juan MD, Barros F, Romero R, Sanz MA. Quantitative assessment of PML-RARa and BCR-ABL by two real-time PCR instruments: multiinstitutional laboratory trial. Clin Chem 2004; 50:1088-92. [PMID: 15161732 DOI: 10.1373/clinchem.2003.028308] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Pascual Bolufer
- Molecular Biology, Department of Medical Biopathology, Hospital Universitario La Fe, Avda Campanar 21, 46009 Valencia, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|