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Incidence of Bcr-Abl kinase domain mutations in imatinib refractory chronic myeloid leukemia patients from South India

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Tumor Biology

Abstract

Mutations in the Bcr-Abl kinase domain (KD) are a major cause for acquired resistance to imatinib (IM) treatment and have been associated with progression and poor prognosis in chronic myeloid leukemia patients. The present study includes 63 patients resistant to standard imatinib dose of 400 mg according to ELN guidelines. Direct sequencing method is used for mutational analysis. The present study revealed 15 exonic mutations in 46.03 % of patients; among them, seven cases (24.13 %) had multiple mutations. Mutations were found to be higher in sokal high- (45.0 %) and intermediate- (68.42 %) compared to low-risk (29.16 %) group. Mutations were observed in 38.09 % of patients with EUTOS (European Treatment and Outcome Study) high risk and in 50.0 % with low risk. The frequency of mutations was 50.0 % in advanced phase, 47.36 % in late chronic-phase, and 43.33 % in chronic-phase patients. 42.10 % of patients with primary resistance and 52.0 % with secondary resistance had mutations. P-loop and T315I mutations were associated with poor survival in advanced phase patients (85.71 %) (P = 0.03). No significant variation was observed with Bcr-Abl transcript levels between the patients with the presence or absence of mutations (P = 0.73). Bcr-Abl levels were found to be significantly elevated in P-loop and T315I mutation carriers (P = 0.001) and also in T315I mutation-positive patients (P = 0.01). P-loop mutations and T315I are frequent in advanced phases and strongly associated with poor prognosis and survival. Hence, the identification of mutations in IM-resistant CML patients will help in treatment optimization with 2nd- or 3rd-generation tyrosine kinase inhibitors (TKIs).

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Acknowledgments

The authors are thankful to the Department of Medical Oncology, NIMS, for supporting this project.

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Authors and Affiliations

  1. Nizams Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, 500082, India

    Sailaja Kagita, Srihari Uppalapati, Sangeeta Jiwatani, Vijay Gandhi Linga, Sadasivudu Gundeti, Narayana Nagesh & Raghunadharao Digumarti

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  1. Sailaja Kagita
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  2. Srihari Uppalapati
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Correspondence to Raghunadharao Digumarti.

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Kagita, S., Uppalapati, S., Jiwatani, S. et al. Incidence of Bcr-Abl kinase domain mutations in imatinib refractory chronic myeloid leukemia patients from South India. Tumor Biol. 35, 7187–7193 (2014). https://doi.org/10.1007/s13277-014-1926-9

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  • DOI: https://doi.org/10.1007/s13277-014-1926-9

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