Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/69143
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Type: Journal article
Title: BCR-ABL transcript dynamics support the hypothesis that leukemic stem cells are reduced during imatinib teatment
Author: Stein, A.
Bottino, D.
Modur, V.
Branford, S.
Kaeda, J.
Goldman, J.
Hughes, T.
Radich, J.
Hochhaus, A.
Citation: Clinical Cancer Research, 2011; 17(21):6812-6821
Publisher: Amer Assoc Cancer Research
Issue Date: 2011
ISSN: 1078-0432
1557-3265
Statement of
Responsibility: 
Andrew M. Stein, Dean Bottino, Vijay Modur, Susan Branford, Jaspal Kaeda, John M. Goldman, Timothy P. Hughes, Jerald P. Radich, and Andreas Hochhaus
Abstract: PURPOSE: Imatinib induces a durable response in most patients with Philadelphia chromosome-positive chronic myeloid leukemia, but it is currently unclear whether imatinib reduces the leukemic stem cell (LSC) burden, which may be an important step toward enabling safe discontinuation of therapy. In this article, we use mathematical models of BCR-ABL levels to make inferences on the dynamics of LSCs. EXPERIMENTAL DESIGN: Patients with at least 1 BCR-ABL transcript measurement on imatinib were included (N = 477). Maximum likelihood methods were used to test 3 potential hypotheses of the dynamics of BCR-ABL transcripts on imatinib therapy: (i) monoexponential, in which there is little, if any, decline in BCR-ABL transcripts; (ii) biexponential, in which patients have a rapid initial decrease in BCR-ABL transcripts followed by a more gradual response; and (iii) triexponential, in which patients first exhibit a biphasic decline but then have a third phase when BCR-ABL transcripts increase rapidly. RESULTS: We found that most patients treated with imatinib exhibit a biphasic decrease in BCR-ABL transcript levels, with a rapid decrease during the first few months of treatment, followed by a more gradual decrease that often continues over many years. CONCLUSIONS: We show that the only hypothesis consistent with current data on progenitor cell turnover and with the long-term, gradual decrease in the BCR-ABL levels seen in most patients is that these patients exhibit a continual, gradual reduction of the LSCs. This observation may explain the ability to discontinue imatinib therapy without relapse in some cases.
Keywords: Humans; Piperazines; Pyrimidines; Fusion Proteins, bcr-abl; RNA, Messenger; Antineoplastic Agents; Protein Kinase Inhibitors; Hematopoiesis; Protein-Tyrosine Kinases; Neoplastic Stem Cells; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Real-Time Polymerase Chain Reaction
Rights: ©2011 American Association for Cancer Research.
RMID: 0020114861
DOI: 10.1158/1078-0432.CCR-11-0396
Appears in Collections:Medicine publications

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