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Pepeler MS, Tıglıoglu M, Dagdas S, Ozhamamcıoglu E, Han U, Albayrak A, Aydın MS, Korkmaz G, Pamukcuoğlu M, Ceran F, Albayrak M, Ozet G. Prognostic Impact of Bone Marrow Fibrosis and Effects of Tyrosine Kinase Inhibitors on Bone Marrow Fibrosis in Chronic Myeloid Leukemia. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:e161-e167. [PMID: 38342726 DOI: 10.1016/j.clml.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 02/13/2024]
Abstract
BACKGROUND Myelofibrosis is reported in around 40% of newly diagnosed chronic myeloid leukemia (CML) patients and have an important role in the pathobiology and prognosis of CML. This retrospective study aimed to evaluate the effects of bone marrow (BM) fibrosis on disease prognosis and the effects of specific tyrosine-kinase inhibitors (TKIs) on BM fibrosis in CML patients. METHODS The study included 96 patients (>18 years) diagnosed with chronic phase (CP) CML. The clinical and demographic information were collected from the medical files. Post-treatment BM aspirate and core biopsy samples were analyzed for the presence of fibrosis and dysplasia. RESULTS The mean age of the study patients was 52.69 years; 47.9% of the patients were female. At the onset, 53 (63.1%) patients had BM fibrosis. The difference in the overall survival of the patients with respect to BM fibrosis grades was significant (p = .001). Within the BM fibrosis grade groups, there were significant differences between grade 0 vs. grade 2, grade 0 vs. grade 3, and grade 1 vs. grade 3 (p = .005, p = .002, and p = .003 respectively) There was no significant association between the presence of BM fibrosis at the onset and not responding to first-line therapy (p = .724). Moreover, no significant association was found between the presence of BM fibrosis at the onset and molecular (p = .623) or cytogenetic response (p = .535) to first-line therapy. Additionally, the association between the type of second-line and third-line therapy and molecular response (p = .773 and p = .424, respectively) or cytogenetic response (p = .298 and p = .641) was not significant. CONCLUSION Although BM fibrosis seems to be a crucial complication of CML with a poor prognosis, it can be reversed via TKI treatment which may result in improved survival. It might be considered to check the BM for this complication on a regular basis during therapies to test its prognostic influence in CML patients in prospective controlled trials. Further studies focused on this issue are required to utilize BM fibrosis as a candidate prognostic factor.
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Affiliation(s)
| | - Mesut Tıglıoglu
- Adult Hematology Deparment, Dıskapı Training and Research Hospital, Ankara, Turkey
| | - Simten Dagdas
- Adult Hematology Deparment, Ankara Bilkent City Hospital, Ankara, Turkey
| | | | - Unsal Han
- Pathology Department, Dıskapı Training and Research Hospital, Ankara, Turkey
| | - Aynur Albayrak
- Pathology Department, Ankara Bilkent City Hospital, Ankara, Turkey
| | | | - Gülten Korkmaz
- Adult Hematology Deparment, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Merve Pamukcuoğlu
- Adult Hematology Deparment, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Funda Ceran
- Adult Hematology Deparment, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Murat Albayrak
- Adult Hematology Deparment, Dıskapı Training and Research Hospital, Ankara, Turkey
| | - Gülsüm Ozet
- Adult Hematology Deparment, Ankara Bilkent City Hospital, Ankara, Turkey
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2
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Atallah EL, Maegawa R, Latremouille-Viau D, Rossi C, Guérin A, Wu EQ, Patwardhan P. Chronic Myeloid Leukemia: Part I-Real-World Treatment Patterns, Healthcare Resource Utilization, and Associated Costs in Later Lines of Therapy in the United States. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2022; 9:19-29. [PMID: 35979528 PMCID: PMC9352872 DOI: 10.36469/001c.36975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/25/2022] [Indexed: 06/15/2023]
Abstract
Background: Despite advances in tyrosine kinase inhibitor (TKI) therapy for chronic myeloid leukemia in chronic phase (CML-CP), a sizeable proportion of patients with CML-CP remains refractory or intolerant to these agents. Objectives: Treatment patterns, healthcare resource utilization (HRU), and costs were evaluated among patients with CML who received third or later lines of therapy (3L+), a clinical population that has not been previously well-studied, with unmet treatment needs as TKI therapy has repeatedly failed. Methods: Adult patients with CML who received 3L+ were identified in the IBM® MarketScan® Databases (January 1, 2001-June 30, 2019) and the SEER-Medicare-linked database (January 1, 2006-December 31, 2016). Treatment patterns were observed from CML diagnosis. HRU and direct healthcare costs (payer's perspective, 2019 USD) were measured in a 3L+ setting. Results: Among 296 commercially insured patients with 3L+ (median age, 58.5 years; female, 49.7%), the median duration of first-line (1L), second-line (2L), and 3L therapy was 8.5, 4.2, and 8.3 months, respectively. The annual incidence rate during 3L+ was 3.4 for inpatient days, 30.8 for days with outpatient services, and 1.2 for emergency department visits. Mean per-patient-per-month (PPPM) total healthcare costs (pharmacy + medical costs) were $18 784 in 3L+, $15 206 in 3L, and $19 546 in 4L, with inpatient costs driving most of the difference between 3L and 4L (mean [3L] = $2528 PPPM, mean [4L] = $6847 PPPM). Among 53 Medicare-insured patients with 3L+ (median age, 72.0 years; female, 39.6%), the median duration of 1L, 2L, and 3L therapy was 9.7, 5.0, and 7.0 months, respectively. During 3L+, the annual incidence rate was 10.3 for inpatient days, 61.9 for days with outpatient services, and 1.5 for emergency department visits. Mean PPPM total healthcare costs were $14 311 in 3L+, $15 100 in 3L, and $16 062 in 4L. Discussion: Patients with CML receiving 3L+ rapidly cycled through multiple lines. Costs increased from 3L to 4L; in commercially insured patients, inpatient costs were responsible for most of the cost increase between 3L and 4L, underlying these patients' continued need for care. Conclusions: These findings support the need for better treatment options in patients with CML undergoing later lines of therapy.
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Affiliation(s)
| | - Rodrigo Maegawa
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | | | | | - Eric Q Wu
- Analysis Group, Inc, Boston, Massachusetts
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Saydam G, Unal A, Haznedaroglu IC, Hacihanifioglu A, Mehtap O, Kurtoglu E, Gocer M, Turgut M, Kelkitli E, Atay MH, Guler N, Koluman BU, Sonmez M, Erkut N, Kaya E, Kuku I, Erkurt MA, Ozet G, Ceran F, Sahin F, Soyer N, Nalcaci M, Yilmaz M, Bozkurt S, Aver B, Ozdengulsun B, Ozbilgili E, Ilhan O. Turkey real-life data: demographic features, treatment results and effects of comorbidities in chronic myeloid leukemia. Int J Hematol Oncol 2022; 11:IJH40. [PMID: 36101779 PMCID: PMC9453544 DOI: 10.2217/ijh-2021-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/09/2022] [Indexed: 11/21/2022] Open
Abstract
Aim: This study aimed to identify patient characteristics, treatment patterns and outcomes and to evaluate the effects of presence of comorbidities at diagnosis in chronic phase (CP)-chronic myeloid leukemia (CML) patients in Turkey. Materials & methods: Hospital records between 2005 and 2018 were retrospectively reviewed. Results: Of 861 CP-CML patients included, 31% had at least one comorbidity at diagnosis. Sex, cardiovascular disease status at diagnosis and molecular (at least major) and cytogenetic (partial and complete) responses were the independent predictors of survival. Conclusion: The response rates of CP-CML patients to the tyrosine kinase inhibitors were satisfactory. In addition to tolerability and side effect profiles of drugs, comorbidity status of patients should also be considered in treatment choice in CML patients. This study aimed to identify patient characteristics, treatment patterns and outcomes and to evaluate the effects of presence of comorbidities at diagnosis in chronic phase (CP)-chronic myeloid leukemia (CML) patients in Turkey. Hospital records of patients between 2005 and 2018 were retrospectively reviewed. Of the included 861 CP-CML patients, 31% had at least one comorbidity at diagnosis. The survival of the patients was affected by sex, cardiovascular disease status at diagnosis, and molecular (at least major) and cytogenetic (partial and complete) responses. The response rates of CP-CML patients to the tyrosine kinase inhibitors were satisfactory. In addition to tolerability and side effect profiles of drugs, comorbidity status of patients should also be considered in treatment choice in CML patients.
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Affiliation(s)
- Guray Saydam
- Department of Internal Diseases, Division of Hematology, Ege University Medical Faculty Hospital, Izmir, 35100, Turkey
| | - Ali Unal
- Department of Internal Diseases, Division of Hematology, Erciyes University Faculty of Medicine, Kayseri, 38030, Turkey
| | | | - Abdullah Hacihanifioglu
- Department of Internal Diseases, Division of Hematology, Kocaeli University Faculty of Medicine, Izmit, 41001, Turkey
| | - Ozgur Mehtap
- Department of Internal Diseases, Division of Hematology, Kocaeli University Faculty of Medicine, Izmit, 41001, Turkey
| | - Erdal Kurtoglu
- Department of Internal Diseases, Division of Hematology, University of Health Sciences, Antalya Training & Research Hospital, Antalya, 07100, Turkey
| | - Mesut Gocer
- Department of Internal Diseases, Division of Hematology, University of Health Sciences, Antalya Training & Research Hospital, Antalya, 07100, Turkey
| | - Mehmet Turgut
- Department of Internal Diseases, Division of Hematology, Ondokuz Mayis University Faculty of Medicine, Samsun, 55139, Turkey
| | - Engin Kelkitli
- Department of Internal Diseases, Division of Hematology, Ondokuz Mayis University Faculty of Medicine, Samsun, 55139, Turkey
| | - Memis Hilmi Atay
- Department of Internal Diseases, Division of Hematology, Ondokuz Mayis University Faculty of Medicine, Samsun, 55139, Turkey
| | - Nil Guler
- Department of Internal Diseases, Pamukkale University Faculty of Medicine, Denizli, 20160, Turkey
| | - Basak Unver Koluman
- Department of Internal Diseases, Pamukkale University Faculty of Medicine, Denizli, 20160, Turkey
| | - Mehmet Sonmez
- Department of Internal Diseases, Division of Hematology, Karadeniz Technical University Faculty of Medicine, Trabzon, 61080, Turkey
| | - Nergiz Erkut
- Department of Internal Diseases, Division of Hematology, Karadeniz Technical University Faculty of Medicine, Trabzon, 61080, Turkey
| | - Emin Kaya
- Department of Internal Diseases, Division of Hematology, Inonu University Faculty of Medicine, Malatya, 44280, Turkey
| | - Irfan Kuku
- Department of Internal Diseases, Division of Hematology, Inonu University Faculty of Medicine, Malatya, 44280, Turkey
| | - Mehmet Ali Erkurt
- Department of Internal Diseases, Division of Hematology, Inonu University Faculty of Medicine, Malatya, 44280, Turkey
| | - Gulsum Ozet
- Department of Hematology, Ankara City Hospital, Ankara, 06800, Turkey
- Department of Internal Diseases, Ankara Yıldırım Beyazit University Faculty of Medicine, Ankara, 06800, Turkey
| | - Funda Ceran
- Department of Hematology, Ankara City Hospital, Ankara, 06800, Turkey
| | - Fahri Sahin
- Department of Internal Diseases, Division of Hematology, Ege University Medical Faculty Hospital, Izmir, 35100, Turkey
| | - Nur Soyer
- Department of Internal Diseases, Division of Hematology, Ege University Medical Faculty Hospital, Izmir, 35100, Turkey
| | - Meliha Nalcaci
- Department of Internal Diseases, Istanbul University Istanbul Faculty of Medicine, Istanbul, 34093, Turkey
| | - Mehmet Yilmaz
- Department of Internal Diseases, Division of Hematology, SANKO University Faculty of Medicine, Gaziantep, 27090, Turkey
| | - Sirac Bozkurt
- Department of Medical Oncology, Pfizer Pharmaceuticals, Istanbul, 34394, Turkey
| | - Birkan Aver
- Department of Medical Oncology, Pfizer Pharmaceuticals, Istanbul, 34394, Turkey
| | - Begum Ozdengulsun
- Department of Medical Oncology, Pfizer Pharmaceuticals, Istanbul, 34394, Turkey
| | - Egemen Ozbilgili
- Department of Medical Oncology, Pfizer Pharmaceuticals, Istanbul, 34394, Turkey
| | - Osman Ilhan
- Department of Internal Diseases, Division of Hematology, Ankara University Faculty of Medicine, Ankara, 06230, Turkey
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Salter B, Burns I, Fuller K, Eshaghpour A, Lionel AC, Crowther M. Tyrosine kinase inhibitors and tumor lysis syndrome in hematologic malignancies: A systemic review. Eur J Haematol 2022; 109:166-181. [PMID: 35531791 DOI: 10.1111/ejh.13786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Effective treatments for hematologic malignancies include therapies that target tyrosine kinase (TK) signaling pathways. Tumor lysis syndrome (TLS) is an oncologic emergency that can occur due to rapid turnover following the initiation of treatments for hematologic malignancy. The incidence of TLS is under-reported and it is unclear as to whether TK inhibitors (TKIs) are associated with TLS. OBJECTIVE To conduct a systematic review to determine the incidence of TLS with TKIs. METHODS A search was performed using EMBASE, MEDLINE, and Web of Science electronic databases, as well as a manual search of the American Society of Hematology and American Society of Clinical Oncology abstract databases. Keywords included: "tumor lysis syndrome," "tyrosine kinase inhibitors," "lymphoma," and "leukemia." RESULTS We identified a total of 57 publications that commented on the incidence of TLS with TKIs for hematologic malignancy. Thirty-nine of those publications reported TLS as an adverse event. TLS was described as an adverse event among essentially all the subclasses of TKIs that are used to manage hematologic malignancies. CONCLUSION The overall number of articles commenting on TLS as an adverse event is sparse and there needs to be more transparency regarding the incidence of TLS when employing newer targeted therapies. Physicians should consider the risk of TLS on an individual basis and the added risk of TLS when using TKIs to treat hematologic malignancy.
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Affiliation(s)
| | - Ian Burns
- McMaster University, Hamilton, Ontario, Canada
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Bonifacio M, Maheshwari V, Tran D, Agostoni G, Filioussi K, Viana R. Economic Model to Evaluate the Cost-Effectiveness of Second-Line Nilotinib Versus Dasatinib for the Treatment of Philadelphia Chromosome-Positive Chronic Myeloid Leukemia (CML-CP) in Italy. PHARMACOECONOMICS - OPEN 2022; 6:95-104. [PMID: 34297312 PMCID: PMC8807738 DOI: 10.1007/s41669-021-00286-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the cost effectiveness of second-line nilotinib versus dasatinib for the treatment of Philadelphia chromosome-positive chronic myeloid leukemia (CML-CP) patients who are intolerant or resistant to imatinib and can transition to treatment-free remission (TFR). METHODS A partitioned survival model was developed to compare the cost effectiveness of nilotinib versus dasatinib. The model was developed from the Italian healthcare payer perspective and included the following health states: on second-line tyrosine kinase inhibitor (TKI), off second-line TKI, accelerated phase/blastic crisis, TFR, and death. Progression-free and overall survival curves were derived from patient-level data that compared nilotinib and dasatinib as second-line therapy in CML-CP patients who were resistant or intolerant to imatinib. Drug costs, healthcare costs, and adverse event costs were based on real-world evidence and publicly available databases. Cost effectiveness was estimated over a 40-year time horizon. Scenario analyses were performed by adjusting time horizon, TFR parameters, costs, and utilities. RESULTS Second-line nilotinib resulted in greater time spent in TFR (0.91 life-years), increased quality-adjusted life-years (QALYs) (1.89), increased life-years (2.16), and decreased per-patient costs (- 38,760 €). Therefore, nilotinib was strongly dominant compared with dasatinib in the base-case analysis. Nilotinib remained strongly dominant in most scenario analyses including shorter time horizon, exclusion of TFR, and varying TKI drug costs. CONCLUSIONS While the model showed that nilotinib treatment of imatinib-intolerant or resistant CML-CP patients was more effective and less costly than dasatinib treatment, there is considerable uncertainty in the findings.
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Affiliation(s)
| | | | - Diana Tran
- EVERSANA Life Science Services, LLC, Burlington, Ontario, Canada
| | - Gianluca Agostoni
- Region Europe Value and Access, Novartis Farma S.p.A, Origgio, Italy
| | - Kalitsa Filioussi
- Region Europe Value and Access, Novartis Farma S.p.A, Origgio, Italy
| | - Ricardo Viana
- Global Value & Access, Oncology, Novartis Pharma AG, WSJ- Fabrikstrasse 18-3.330, 4056, Basel, Switzerland.
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Influence of Telomere Length on the Achievement of Deep Molecular Response With Imatinib in Chronic Myeloid Leukemia Patients. Hemasphere 2021; 5:e657. [PMID: 34853825 PMCID: PMC8615316 DOI: 10.1097/hs9.0000000000000657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/11/2021] [Indexed: 11/26/2022] Open
Abstract
Tyrosine kinase inhibitors have dramatically changed the outcome of chronic myeloid leukemia (CML), and nowadays, one of the main treatment goals is the achievement of deep molecular responses (DMRs), which can eventually lead to therapy discontinuation approaches. Few biological factors at diagnosis have been associated with this level of response. Telomere length (TL) in peripheral blood cells of patients with CML has been related to disease stage, response to therapy and disease progression, but little is known about its role on DMR. In this study, we analyzed if age-adjusted TL (referred as “delta-TL”) at diagnosis of chronic phase (CP)-CML might correlate with the achievement of DMR under first-line imatinib treatment. TL from 96 CP-CML patients had been retrospectively analyzed at diagnosis by monochrome multiplex quantitative PCR. We observed that patients with longer age-adjusted telomeres at diagnosis had higher probabilities to achieve DMR with imatinib than those with shortened telomeres (P = 0.035 when delta-TL was studied as a continuous variable and P = 0.047 when categorized by the median). Moreover, patients carrying long telomeres also achieved major molecular response significantly earlier (P = 0.012). This study provides proof of concept that TL has a role in CML biology and when measured at diagnosis of CP-CML could help to identify patients likely to achieve DMR to first-line imatinib treatment.
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Leukemia Stem Cells as a Potential Target to Achieve Therapy-Free Remission in Chronic Myeloid Leukemia. Cancers (Basel) 2021; 13:cancers13225822. [PMID: 34830976 PMCID: PMC8616035 DOI: 10.3390/cancers13225822] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/26/2022] Open
Abstract
Leukemia stem cells (LSCs, also known as leukemia-initiating cells) not only drive leukemia initiation and progression, but also contribute to drug resistance and/or disease relapse. Therefore, eradication of every last LSC is critical for a patient's long-term cure. Chronic myeloid leukemia (CML) is a myeloproliferative disorder that arises from multipotent hematopoietic stem and progenitor cells. Tyrosine kinase inhibitors (TKIs) have dramatically improved long-term outcomes and quality of life for patients with CML in the chronic phase. Point mutations of the kinase domain of BCR-ABL1 lead to TKI resistance through a reduction in drug binding, and as a result, several new generations of TKIs have been introduced to the clinic. Some patients develop TKI resistance without known mutations, however, and the presence of LSCs is believed to be at least partially associated with resistance development and CML relapse. We previously proposed targeting quiescent LSCs as a therapeutic approach to CML, and a number of potential strategies for targeting insensitive LSCs have been presented over the last decade. The identification of specific markers distinguishing CML-LSCs from healthy HSCs, and the potential contributions of the bone marrow microenvironment to CML pathogenesis, have also been explored. Nonetheless, 25% of CML patients are still expected to switch TKIs at least once, and various TKI discontinuation studies have shown a wide range in the incidence of molecular relapse (from 30% to 60%). In this review, we revisit the current knowledge regarding the role(s) of LSCs in CML leukemogenesis and response to pharmacological treatment and explore how durable treatment-free remission may be achieved and maintained after discontinuing TKI treatment.
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Cortes J, Pavlovsky C, Saußele S. Chronic myeloid leukaemia. Lancet 2021; 398:1914-1926. [PMID: 34425075 DOI: 10.1016/s0140-6736(21)01204-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 01/04/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023]
Abstract
Tyrosine-kinase inhibitors have changed the natural history of chronic myeloid leukaemia in such a way that patients with adequate access to these agents, who are properly managed, and who respond well to this treatment can expect a near-normal life expectancy. Achieving this goal requires an adequate understanding of the patient's treatment goals, careful monitoring for the achievement of optimal response hallmarks, implementation of proper interventions according to the attainment of such endpoints, adequate recognition and management of adverse events, and acknowledgment of the relevance of comorbidities. Treatment with tyrosine-kinase inhibitors, once considered lifelong, has become terminable for at least some patients, and promising new agents are emerging for those whose disease does not respond to any of the multiple therapeutic options currently available. If these advances reach all patients with chronic myeloid leukaemia, cure might eventually become a reality in most instances.
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Affiliation(s)
- Jorge Cortes
- Georgia Cancer Center, Augusta University, Augusta, GA, USA.
| | | | - Susanne Saußele
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
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Loscocco F, Visani G, Ruzzo A, Bagaloni I, Fuligni F, Galimberti S, Di Paolo A, Stagno F, Pregno P, Annunziata M, Gozzini A, Barulli S, Gabucci E, Magnani M, Isidori A. Clinical Relevance of ABCB1, ABCG2, and ABCC2 Gene Polymorphisms in Chronic Myeloid Leukemia Patients Treated With Nilotinib. Front Oncol 2021; 11:672287. [PMID: 34055641 PMCID: PMC8155509 DOI: 10.3389/fonc.2021.672287] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/21/2021] [Indexed: 12/05/2022] Open
Abstract
Tyrosine kinase inhibitors (TKIs) have radically changed the outcome of chronic myeloid leukemia (CML) patients in the last 20 years. Moreover, the advent of second generation TKIs, namely nilotinib and dasatinib, have largely increased the number of CML patients achieving deep and sustained molecular responses. However, the possible mechanisms capable of influencing the maintenance of the long-term molecular response are not yet fully known and understood. In this light, polymorphisms in MDR-ABC transporters may influence the efficacy and safety of TKIs. In this study, we examined seven single nucleotide polymorphisms (SNPs) in four ABC transporter genes: ABCC1 rs212090 (5463T>A), ABCC2 rs3740066 (3972C>T), ABCC2 rs4148386 G>A, ABCC2 rs1885301 (1549G>A), ABCG2 rs2231137 (34G>A), ABCG2 rs2231142 G>C, ABCB1 rs1045642 (3435C>T), to determine their effect on the achievement and/or loss of molecular response in 90 CML patients treated with nilotinib. We found that ABCC2 rs3740066 CC and CT as well as the ABCB1 rs1045642 TT genotypes correlated with a higher probability to achieve MR3 in a shorter time (p=0.02, p=0.004, and p=0.01), whereas ABCG2 rs2231137 GG was associated with lower probability of MR3 achievement (p=0.005). Moreover, ABCC2 rs3740066 CC genotype, the ABCB1 rs1045642 CC and TT genotypes were positively correlated with MR4 achievement (p=0.02, p=0.007, and p=0.003). We then generated a predictive model incorporating the information of four genotypes, to evaluate the combined effect of the SNPs. The combination of SNPs present in the model affected the probability and the time to molecular response. This model had a high prognostic significance for both MR3 and MR4 (p=0.005 and p=0.008, respectively). Finally, we found ABCG2 rs2231142 GG genotype to be associated with a decrease risk of MR3 loss. In conclusion, MDR-transporters SNPs may significantly affect the achievement and loss of molecular response in CML patients treated with nilotinib.
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Affiliation(s)
- Federica Loscocco
- Hematology and Hematopoietic Stem Cell Transplant Center, AORMN, Pesaro, Italy
| | - Giuseppe Visani
- Hematology and Hematopoietic Stem Cell Transplant Center, AORMN, Pesaro, Italy
| | - Annamaria Ruzzo
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Fano, Italy
| | - Irene Bagaloni
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Fano, Italy
| | - Fabio Fuligni
- Genetics and Genome Biology, Paediatric Laboratory Medicine (PLM), The Hospital for Sick Children, Toronto, ON, Canada
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonello Di Paolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Stagno
- AOU Policlinico Vittorio Emanuele, Divisioni Clinicizzata di Ematologia con Trapianto di Midollo Osseo, Catania, Italy
| | - Patrizia Pregno
- AOU Città Della Scienza e Della Salute di Torino, Hematology, Torino, Italy
| | | | | | - Sara Barulli
- Hematology and Hematopoietic Stem Cell Transplant Center, AORMN, Pesaro, Italy
| | - Elisa Gabucci
- Hematology and Hematopoietic Stem Cell Transplant Center, AORMN, Pesaro, Italy
| | - Mauro Magnani
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Fano, Italy
| | - Alessandro Isidori
- Hematology and Hematopoietic Stem Cell Transplant Center, AORMN, Pesaro, Italy
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Al-Jadir RI, Alalsaidissa J. Mutational analysis of T315I in patients with chronic myeloid leukemia who did not respond to second-generation tyrosine kinase inhibitors. IRAQI JOURNAL OF HEMATOLOGY 2020. [DOI: 10.4103/ijh.ijh_31_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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