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Blood, 1 October 2007, Vol. 110, No. 7, pp. 2242-2249.
Prepublished online as a Blood First Edition Paper on May 11, 2007; DOI 10.1182/blood-2007-03-066936.


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Submitted March 21, 2007
Accepted May 7, 2007

Bcr-Abl kinase domain mutations, drug resistance and the road to a cure of chronic myeloid leukemia

Thomas O'Hare, Christopher A. Eide, and Michael WN Deininger*

Howard Hughes Medical Institute, Oregon Health & Science University, Portland, Oregon, United States
OHSU Cancer Institute, Oregon Health & Science University, Portland, Oregon, United States

* Corresponding author; email: deininge{at}ohsu.edu.

Mutations in the kinase domain (KD) of Bcr-Abl are the most prevalent mechanism of acquired imatinib resistance in patients with chronic myeloid leukemia (CML). Here we examine predisposing factors underlying acquisition of KD mutations, evidence for acquisition of mutations prior to and during therapy, and whether the detection of a KD mutation universally implies resistance. We also provide a perspective on how the second-line Abl inhibitors dasatinib and nilotinib are faring in the treatment of imatinib-resistant CML, especially in relation to specific KD mutations. We discuss the growing importance of the multi-inhibitor-resistant T315I mutant and the therapeutic potential that a T315I inhibitor would have. Lastly, we assess the potential of Abl kinase inhibitor combinations to induce stable responses even in advanced CML and interpret the emerging data in the context of CML pathogenesis.


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