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Prepublished online as a Blood First Edition Paper on March 27, 2003; DOI 10.1182/blood-2002-06-1756.

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2002-06-1756v1
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Submitted June 13, 2002
Accepted March 13, 2003

Presence of the BCR-ABL mutation E255K prior to STI571 (Imatinib) treatment in patients with Ph+ acute lymphoblastic leukemia

Wolf-Karsten Hofmann*, Martina Komor, Barbara Wassmann, Letetia C Jones, Harald Gschaidmeier, Dieter Hoelzer, H Phillip Koeffler, and Oliver G Ottmann

Department of Hematology, University Hospital, Frankfurt/Main, Germany
Division of Hematology/Oncology, Cedars Sinai Research Institute, UCLA School of Medicine, Los Angeles, CA, USA
Novartis Pharma AG, Nuremberg, Germany

* Corresponding author; email: W.K.Hofmann{at}em.uni-frankfurt.de.

The tyrosine kinase inhibitor STI571 (Imatinib) binds competitively to the ATP binding site of the ABL kinase, thereby inhibiting auto- and substrate phosphorylation of the oncogenic protein BCR-ABL and preventing the activation of downstream signaling pathways. Comparative studies on leukemic cell samples obtained from CML and Ph+ ALL patients before and after treatment with STI571 reported point mutations in resistant samples after a short time of therapy. The aim of this study was to determine whether or not patients with Ph+ ALL in whom resistance developed as a consequence of the E255K mutation already harboured this subclone prior to STI571 treatment. First, the migration pattern of cDNA's from 30 bone marrow samples from patients with Ph+ ALL was analyzed by PCR-SSCP. Thereafter, detailed mutational analysis using genomic DNA was performed on initial STI571 naive bone marrow samples of 4 individuals with Ph+ ALL, for whom the mutation E255K in association with STI571-treatment had been shown. A 166 bp PCR-fragment spanning from nt 862 to nt 1027 was cloned and 108 clones per sample were analyzed by direct sequencing. This more sensitive technique revealed presence of the E255K mutation in 2 initial samples, one clone each. We identified for the first time the mutation E255K in STI571-naive leukemic samples of Ph+ ALL-patients. The findings suggest that the mutation exists in a very small sub-population of leukemic cells at the beginning of STI571 therapy.


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