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International Journal of Hematology

, Volume 80, Issue 1, pp 62–66 | Cite as

Existence of Leukemic Clones Resistant to Both Imatinib Mesylate and Rituximab before Drug Therapies in a Patient with Philadelphia Chromosome-Positive Acute Lymphocytic Leukemia

  • Takaaki Hato
  • Jun Yamanouchi
  • Tatsushiro Tamura
  • Norimasa Hojo
  • Yasunari Niiya
  • Masashi Kohno
  • Shiro Bando
  • Yoshihiro Yakushijin
  • Kiyonori Takada
  • Ikuya Sakai
  • Masaki Yasukawa
  • Shigeru Fujita
Article

Abstract

Imatinib mesylate and rituximab are molecularly targeted drugs against the BCR-ABL fusion protein and the CD20 antigen, respectively. Although these drugs have excellent anticancer effects, a major concern is drug resistance. We have investigated the case of a patient with Philadelphia chromosome-positive and CD20+ acute lymphocytic leukemia who acquired resistance to imatinib and rituximab. Imatinib therapy resulted in prompt cytogenetic remission, but resistance developed shortly thereafter. Sequencing of the kinase domain of the ABL gene and allele-specific polymerase chain reaction analysis revealed a point mutation resulting in an E255V substitution that was present before the therapy. After the patient received mild chemotherapy followed by rituximab administration, hematologic and cytogenetic remission was sustained for 5.5 months. The recurrent leukemic cells after the rituximab therapy showed not only the E255V mutation in the ABL gene but also loss of the CD20 antigen due to impaired transcription of the CD20 gene. The results of 2-color flow cytometry analysis showed that a small population of CD20- leukemic cells existed before the imatinib therapy. These results suggest that leukemic subclones carrying a genetic perturbation of the targeted molecules for both imatinib and rituximab were present before the therapies. The preexistence of primary resistant clones suggests the inability of combination therapy with 2 molecularly targeted drugs to overcome drug resistance in leukemia.

Key words

Imatinib mesylate Rituximab Resistance Acute lymphocytic leukemia t(1:9)(q21:p13) 

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Copyright information

© The Japanese Society of Hematology 2004

Authors and Affiliations

  • Takaaki Hato
    • 1
  • Jun Yamanouchi
    • 2
  • Tatsushiro Tamura
    • 2
  • Norimasa Hojo
    • 2
  • Yasunari Niiya
    • 2
  • Masashi Kohno
    • 2
  • Shiro Bando
    • 3
  • Yoshihiro Yakushijin
    • 2
  • Kiyonori Takada
    • 2
  • Ikuya Sakai
    • 2
  • Masaki Yasukawa
    • 2
  • Shigeru Fujita
    • 2
  1. 1.Division of Blood TransfusionEhime University School of MedicineShitsukawa, Shigenobu, Onsen-gun, EhimeJapan
  2. 2.Departments of Internal Medicine 1Ehime University School of MedicineEhimeJapan
  3. 3.Departments of Laboratory MedicineEhime University School of MedicineEhimeJapan

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