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Blood, 15 August 2006, Vol. 108, No. 4, pp. 1328-1333.
Prepublished online as a Blood First Edition Paper on April 13, 2006; DOI 10.1182/blood-2005-12-010132.
Previous Article | Next Article 
Submitted December 16, 2005
Accepted March 30, 2006
Bcr-Abl resistance screening predicts a limited spectrum
of point mutations to be associated with clinical
resistance to the Abl kinase inhibitor nilotinib (AMN107)
Nikolas von Bubnoff*, Paul W Manley, Jurgen Mestan, Jana Sanger, Christian Peschel, and Justus Duyster
Department of Internal Medicine III, Technical University of Munich, Munich, Germany
Novartis Institutes of Biomedical Research, Basel, Switzerland
* Corresponding author; email: n.bubnoff{at}lrz.tum.de.
In advanced-phase CML, resistance to imatinib mesylate
is associated with point mutations in the Bcr-Abl kinase
domain. A new generation of potent Abl kinase inhibitors
is undergoing clinical evaluation. It is important to
generate specific resistance profiles for each of these
compounds, which could translate into combinatorial and
sequential treatment strategies. Having characterized
nilotinib (AMN107) against a large panel of imatinib-
resistant Bcr-Abl mutants, we investigated which mutants
might arise under nilotinib therapy using a cell based
resistance screen. In contrast to imatinib mesylate,
resistance to nilotinib was associated with a limited
spectrum of Bcr-Abl kinase mutations. Among these were
mutations affecting the P-loop and T315I. Rarely
emerging resistant colonies at a concentration of 400 nM
nilotinib exclusively expressed the T315I mutation. With
the exception of T315I, all of the mutations that were
identified were effectively suppressed when the
nilotinib concentration was increased to 2000 nM, which
falls within the peak - trough range in plasma levels
(3.6 - 1.7 µM) measured in patients treated with 400 mg
bid. Our findings suggest that nilotinib might be
superior to imatinib in terms of the development of
resistance. However, our study indicates that clinical
resistance to nilotinib may be associated with the
predominant emergence of T315I.

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