J Cancer 2020; 11(8):2234-2240. doi:10.7150/jca.38752 This issue

Research Paper

BCR-ABL1 transcript decline ratio combined BCR-ABL1IS as a precise predictor for imatinib response and outcome in the patients with chronic myeloid leukemia

Zhimei Cai1,2, Xiting Jia2, Jie Zi1, Huihui Song1, Shujun Wang1, Mary McGrath3, Lidong Zhao2✉, Chunhua Song3✉, Zheng Ge1✉

1. Department of Hematology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
2. Department of Hematology, The First People's Hospital of Lianyungang, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, China
3. Hershey Medical Center, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA

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Citation:
Cai Z, Jia X, Zi J, Song H, Wang S, McGrath M, Zhao L, Song C, Ge Z. BCR-ABL1 transcript decline ratio combined BCR-ABL1IS as a precise predictor for imatinib response and outcome in the patients with chronic myeloid leukemia. J Cancer 2020; 11(8):2234-2240. doi:10.7150/jca.38752. Available from https://www.jcancer.org/v11p2234.htm

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Abstract

Purpose: The early BCR-ABL1 reduction had the prognostic impact of the chronic-phase chronic myeloid leukemia (CML-CP) patients. This study was to find a more precise early prognosis index at 3 months in the patients with newly diagnosed CML-CP, especially for the patients with BCR-ABL1IS >10%.

Methods: We retrospectively analyzed the data of 79 newly diagnosed CML-CP patients from October 2013 to April 2017. All patients took imatinib regularly and continuously and monitored BCR-ABL1 transcript level at baseline and 3, 6, 9, 12, 18 months after starting imatinib treatment.

Results: Among the 44(55.7%) patients with BCR/ABL1IS ≤10% at 3 months after imatinib treatment, 12(27.3%) cases did not achieve major molecular response (MMR) at 12 months, and 7(14.9%) patients with the halving time BCR-ABL1 transcript ≤40 days failed to achieve MMR at 12 months. However, approximately twenty-six percent of the patients with BCR-ABL1IS >10% still obtained MMR. Moreover, the patients with BCR-ABL1IS ≤10% and halving time ≤40 days had a significantly better MMR than that of the patients with the BCR-ABL1IS ≤10% and halving time >40 days (88.6% versus 11.1%, P <0.001). However, the patients with the BCR-ABL1IS >10% and halving time >40 days rarely achieved MMR at 12 months.

Conclusion: These data indicated that the halving time of BCR-ABL1 transcript was also an important prognostic factor as that of the BCR-ABL1IS. Combined observations of these two prognosis indexes are more accurate predictor for the long-term molecular response, especially for the CML-CP patients with BCR-ABL1IS >10%, and which is helpful for TKI switching as early as possible to improve patients' survival and reduce drug costs.

Keywords: chronic myeloid leukemia, imatinib, BCR-ABL1, decline