Influence of BCR-ABL Transcript Type on Outcome in Patients with Chronic-Phase Chronic Myeloid Leukemia Treated with Imatinib

• Published in: Clinical lymphoma, myeloma and leukemia Vol. 17; no. 11; pp. 728 - 733
• Main Authors: Pagnano, Katia Borgia Barbosa, Miranda, Eliana Cristina, Delamain, Márcia Torresan, Duarte, Gislaine Oliveira, de Paula, Erich Vinicius, Lorand-Metze, Irene, de Souza, Carmino Antonio
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2017
• Subjects: Adult; Aged; Aged, 80 and over; BCR-ABL transcripts; CML; Female; Hematology, Oncology and Palliative Medicine; Humans; Imatinib Mesylate - pharmacology; Imatinib Mesylate - therapeutic use; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - drug therapy; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - mortality; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - pathology; Male; Middle Aged; Molecular response; Prognosis; Survival; Survival Analysis; Treatment Outcome; Tyrosine kinase inhibitor; Young Adult; event-free survival (EFS); BCR-ABL; survival; chronic phase (CP); imatinib; Chronic myeloid leukemia; progression-free survival (PFS); chronic myeloid leukemia (CML); overall survival (OS); real time quantitative PCR (RQ-PCR); CML; BCR-ABL transcripts; Tyrosine kinase inhibitor; Molecular response; Survival
• ISSN: 2152-2650; 2152-2669
• DOI: 10.1016/j.clml.2017.06.009

Abstract Background The prognostic significance of BCR-ABL1 transcripts in chronic myeloid leukemia (CML) is still controversial. Methods All consecutive CML patients in chronic phase treated with imatinib in a single center were analyzed (n=170). BCR-ABL1 transcript was evaluated by multiplex RT-PCR. Exclusively patients with BCR-ABL transcripts e13a2 and/or e14a2 were included in this analysis. Results Patients with e14a2 transcripts presented higher rates of optimal molecular responses at 3 months and higher rates of CCyR at 6 months. E13a2, e14a2 and e14a2+e13a2 groups presented similar rates of 5-year event-free, progression-free and overall survival. There was a superior 10-year overall survival in patients with transcripts e13a2 compared to e14a2 (alone or coexpressed with e13a2) (93% vs. 73%, P=0.03), although the 5-year overall survival was 96% vs. 88%, respectively (P=NS). In a multivariate analysis, high/intermediate Sokal score and e14a3/e14a3+e14a2 were independent factors for poor overall survival (HR= 4.63, P=0.023 for Sokal score and HR= 10.6, 0.041 for BCR-ABL transcript). Conclusions Patients with BCR-ABL transcripts e14a2 transcripts have higher rates of CCyR at 6 months and higher rates of optimal molecular response at 3 months when compared to e13a2 or to both transcripts, but no difference in 5-year overall, progression-free and event-free survival. There was a superior 10-year overall survival among patients with transcripts e13a2 compared to e14a2 (alone or coexpressed with e13a2).