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在对伊马替尼产生稳定完全细胞遗传学反应的少数患者中,BCR-ABL激酶结构域发生突变。

Mutations of the BCR-ABL-kinase domain occur in a minority of patients with stable complete cytogenetic response to imatinib.

作者信息

Sherbenou D W, Wong M J, Humayun A, McGreevey L S, Harrell P, Yang R, Mauro M, Heinrich M C, Press R D, Druker B J, Deininger M W

机构信息

Cell and Developmental Biology, Oregon Health & Science University, Portland, OR 97239, USA.

出版信息

Leukemia. 2007 Mar;21(3):489-93. doi: 10.1038/sj.leu.2404554. Epub 2007 Jan 25.

Abstract

Residual leukemia is demonstrable by reverse transcriptase-polymerase chain reaction in most patients with chronic myeloid leukemia who obtain a complete cytogenetic response (CCR) to imatinib. In patients who relapse during imatinib therapy, a high rate of mutations in the kinase domain of BCR-ABL have been identified, but the mechanisms underlying disease persistence in patients with a CCR are poorly characterized. To test whether kinase domain mutations are a common mechanism of disease persistence, we studied patients in stable CCR. Mutations were demonstrated in eight of 42 (19%) patients with successful amplification and sequencing of BCR-ABL. Mutation types were those commonly associated with acquired drug resistance. Four patients with mutations had a concomitant rise of BCR-ABL transcript levels, two of whom subsequently relapsed; the remaining four did not have an increase in transcript levels and follow-up samples, when amplifiable, were wild type. BCR-ABL-kinase domain mutations in patients with a stable CCR are infrequent, and their detection does not consistently predict relapse. Alternative mechanisms must be responsible for disease persistence in the majority of patients.

摘要

在大多数对伊马替尼获得完全细胞遗传学缓解(CCR)的慢性髓性白血病患者中,通过逆转录酶-聚合酶链反应可检测到残留白血病。在伊马替尼治疗期间复发的患者中,已鉴定出BCR-ABL激酶结构域的高突变率,但CCR患者疾病持续存在的潜在机制尚不清楚。为了测试激酶结构域突变是否是疾病持续存在的常见机制,我们研究了处于稳定CCR的患者。在42例成功扩增并测序BCR-ABL的患者中,有8例(19%)检测到突变。突变类型是那些通常与获得性耐药相关的类型。4例有突变的患者BCR-ABL转录水平同时升高,其中2例随后复发;其余4例转录水平未升高,可扩增的随访样本为野生型。稳定CCR患者中BCR-ABL激酶结构域突变并不常见,其检测并不能始终预测复发。大多数患者疾病持续存在的原因必定是其他机制。

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