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Blood, 1 May 2002, Vol. 99, No. 9, pp. 3472-3475
BRIEF REPORT
High frequency of point mutations clustered within the adenosine
triphosphate-binding region of BCR/ABL in patients with
chronic myeloid leukemia or Ph-positive acute lymphoblastic
leukemia who develop imatinib (STI571)
resistance
Susan Branford,
Zbigniew Rudzki,
Sonya Walsh,
Andrew Grigg,
Chris Arthur,
Kerry Taylor,
Richard Herrmann,
Kevin P. Lynch, and
Timothy P. Hughes
From the Institute of Medical and Veterinary
Science, Adelaide; Royal Melbourne Hospital; Royal North Shore
Hospital, Sydney; Mater Hospital, Brisbane; Royal Perth Hospital;
and Novartis Pharmaceuticals Australia, Sydney, Australia.
Point mutations were found in the adenosine triphosphate (ATP)
binding region of BCR/ABL in 12 of 18 patients with chronic myeloid
leukemia (CML) or Ph-positive acute lymphoblastic leukemia (Ph+ ALL) and imatinib resistance (defined as loss of
established hematologic response), but they were found in only 1 of 10 patients with CML with imatinib refractoriness (failure to achieve
cytogenetic response). In 10 of 10 patients for whom samples were
available, the mutation was not detected before the initiation of
imatinib therapy. Three mutations (T315I, Y253H, and F317L present in
3, 1, and 1 patients, respectively) have a predicted role in abrogating imatinib binding to BCR/ABL, whereas 3 other mutations (E255K, G250E,
and M351T, present in 4, 2, and 2 patients, respectively) do not. Thus
we confirm a high frequency of mutations clustered within the
ATP-binding region of BCR/ABL in resistant patients. Screening may
allow intervention before relapse by identifying emerging mutations
with defined impacts on imatinib binding. Certain mutations may respond
to higher doses of imatinib, whereas other mutations may mandate
switching to another therapeutic strategy.

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