Contribution of BCR-ABL molecular variants and leukemic stem cells in response and resistance to tyrosine kinase inhibitors: a review

A nomogram for predicting T315I-free survival in chronic phase chronic myeloid leukemia patients: a multicenter retrospective study

The T315I mutation poses a significant threat to patients with chronic phase chronic myeloid leukemia (CP-CML). This study aimed to establish a nomogram to predict the risk of T315I mutation in CP-CML patients. The training cohort included 1,466 patients from 24 hematology centers, and the validation cohort included 820 patients from an additional 20 centers. Peripheral blood blast (PBB), additional chromosomal abnormality (ACA), dasatinib use, non-EMR at 3 months, and BCR::ABLIS > 1% at 6 months were identified as independent risk factors through multivariate Cox regression analysis. The performance of the nomogram was assessed via receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). The area under the ROC curve (AUC) values at 5, 10, and 15 years were 0.874, 0.925, and 0.930 for the training cohort, and 0.864, 0.814, and 0.803 for the validation cohort, respectively. The calibration curves for both cohorts were close to the ideal diagonal, and the decision curves indicated clinical net benefit. In conclusion, we developed a nomogram to predict the 5-year, 10-year, and 15-year T315I-free survival probabilities of CP-CML patients. This tool can aid clinicians in the early prediction and timely management of high-risk CP-CML patients with the T315I mutation.

Mechanisms underlying therapeutic resistance of tyrosine kinase inhibitors in chronic myeloid leukemia

Chronic myeloid leukemia (CML) is a malignant clonal disease involving hematopoietic stem cells that is characterized by myeloid cell proliferation in bone marrow and peripheral blood, and the presence of the Philadelphia (Ph) chromosome with BCR-ABL fusion gene. Treatment of CML has dramatically improved since the advent of tyrosine kinase inhibitors (TKI). However, there are a small subset of CML patients who develop resistance to TKI. Mutations in the ABL kinase domain (KD) are currently recognized as the leading cause of TKI resistance in CML. In this review, we discuss the concept of resistance and summarize recent advances exploring the mechanisms underlying CML resistance. Overcoming TKI resistance appears to be the most successful approach to reduce the burden of leukemia and enhance cures for CML. Advances in new strategies to combat drug resistance may rapidly change the management of TKI-resistant CML and expand the prospects for available therapies.