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Prepublished online as a Blood First Edition Paper on October 24, 2002; DOI 10.1182/blood-2002-05-1366.
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Blood, 15 March 2003, Vol. 101, No. 6, pp. 2152-2155
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Brief report
High levels of BAX, low levels of MRP-1,
and high platelets are independent predictors of response to imatinib
in myeloid blast crisis of CML
Thoralf Lange,
Christine Günther,
Thomas Köhler,
Rainer Krahl,
Scarlet Musiol,
Sabine Leiblein,
Haifa-Kathrin Al-Ali,
Iris van
Hoomissen,
Dietger Niederwieser, and
Michael W. N. Deininger
From the Department of Hematology, University of
Leipzig, Germany; Roboscreen Gesellschaft für molekulare
Biotechnologie, Leipzig, Germany; Novartis Pharma, Basel, Switzerland;
and BMT/Leukemia Center, Oregon Health and Science University (OHSU),
Portland, OR.
Imatinib induces remissions in approximately 30% of patients with
chronic myeloid leukemia (CML) in myeloid blast crisis (M-BC). Because
most patients eventually relapse, allogeneic stem cell transplantation
(SCT) in remission offers the best chance for cure. Remission induction
with imatinib alone would seem ideal because it is less toxic than
conventional chemotherapy. Conversely, patients unlikely to respond may
benefit from combination therapy up front. To identify
prognostic factors, we studied the mRNA expression of genes related to
drug resistance and apoptosis in leukemic cells from patients with M-BC
and their in vitro sensitivity to imatinib, and analyzed the results
with other baseline factors for their impact on response. We show that
high levels of BAX, low levels of MRP-1, and a
high platelet count are independently predictive of response to
imatinib. Combined into a score, these parameters may be clinically
useful for risk-adapted patient stratification.
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