Monitoring Of Bcr-abl Levels In Chronic Myeloid Leukemia Patients Treated With Imatinib In The Chronic Phase - The Importance Of A Major Molecular Response

Background: Real time PCR has become the most common technique to monitor BCR-ABL transcript levels of patients treated with kinase inhibitors. The aim of this study was to evaluate BCR-ABL levels of chronic myeloid leukemia patients treated with imatinib in the chronic phase and correlate the response to therapy and event-free survival. Methods: BCR-ABL levels were measured in peripheral blood cell samples using Real time PCR at diagnosis and then every 3 months after starting therapy with imatinib. Major molecular response was defined as a three-log reduction from the standardized baseline value. Major molecular response values were adjusted to international scale using a conversion factor of 1.19. The results are reported as a BCR-ABL/ABL ratio (%). Results: Hematological, major cytogenetic and complete cytogenetic responses were achieved by 57 (95%), 45 (75%) and 38 (63%) patients, respectively. Twenty-four out of sixty patients achieved a major molecular response (40%) in a median time of 8.5 months. Overall survival and event free survival were higher for patients with (100%) versus patients without (77%) a complete cytogenetic response (p-value = 0.01) at 48 months. Patients with complete cytogenetic response and major molecular response had a higher event free survival compared to patients with complete cytogenetic response but without major molecular response (p-value = 0.007). Conclusion: In conclusion, the prognostic impact of achieving complete cytogenetic response and a major molecular response and also the importance of molecular monitoring in the follow-up of chronic myeloid leukemia patients were demonstrated.333211215Melo, J.V., The molecular biology of chronic myeloid leukaemia (1996) Leukemia, 10 (5), pp. 751-756Wang, L., Pearson, K., Pillitteri, L., Ferguson, J.E., Clark, R.E., Serial monitoring of BCR-ABL by peripheral blood real-time polymerase chain reaction predicts the marrow cytogenetic response to imatinib mesylate in chronic myeloid leukaemia (2002) Br J Haematol, 118 (3), pp. 771-777Muller, M.C., Gattermann, N., Lahaye, T., Deininger, M.W., Berndt, A., Fruehauf, S., Dynamics of BCR-ABL mRNA expression in firstline therapy of chronic myelogenous leukemia patients with imatinib or interferon alpha/ara-C (2003) Leukemia, 17 (12), pp. 2392-2400Branford, S., Hughes, T.P., Rudzki, Z., Monitoring chronic myeloid leukaemia therapy by real-time quantitative PCR in blood is a reliable alternative to bone marrow cytogenetics (1999) Br J Haematol, 107 (3), pp. 587-599Radich, J.P., Gooley, T., Bryant, E., Chauncey, T., Clift, R., Beppu, L., The significance of bcr-abl molecular detection in chronic myeloid leukemia patients late, 18 months or more after transplantation (2001) Blood, 98 (6), pp. 1701-1707Hughes, T.P., Kaeda, J., Branford, S., Rudzki, Z., Hochhaus, A., Hensley, M.L., Frequency of major molecular responses to imatinib or interferon-alpha plus cytarabine in newly diagnosed chronic myeloid leukemia (2003) N Engl J Med, 349 (15), pp. 1423-1432Press, R.D., Love, Z., Tronnes, A.A., Yang, R., Tran, T., Mongoue- tchokote, S., BCR-ABL mRNA levels at and after the time of a complete cytogenetic response predict the duration of CCR in imatinib mesylate-treated patients with CML (2006) Blood, 107 (11), pp. 4250-4256Cortes, J., Talpaz, M., O'Brien, S., Jones, D., Luthra, R., Shan, J., Molecular responses in patients with chronic myelogenous leukemia in chronic phase treated with imatinib mesylate (2005) Clin Cancer Res, 11 (9), pp. 3425-3432Iacobucci, I., Saglio, G., Rosti, G., Testoni, N., Pane, F., Amabile, M., Achieving a major molecular response at the time of a complete cytogenetic response (CCgR) predicts a better duration of CCgR in imatinib-treated chronic myeloid leukemia patients (2006) Clin Cancer Res, 12 (10), pp. 3037-3042Baccarani, M., Saglio, G., Goldman, J., Hochhaus, A., Simonsson, B., Appelbaum, F., Evolving concepts in the management of chronic myeloid leukemia: Recommendations from an expert panel on behalf of the European LeukemiaNet (2006) Blood, 108 (6), pp. 1809-1820Hughes, T., Deininger, M., Hochhaus, A., Branford, S., Radich, J., Kaeda, J., Monitoring CML patients responding to treatment with tyrosine kinase inhibitors: Review and recommendations for harmonizing current methodology for detecting BCR-ABL transcripts and kinase domain mutations and for expressing results (2006) Blood, 108 (1), pp. 28-37Branford, S., Cross, N.C., Hochhaus, A., Radich, J., Saglio, G., Kaeda, J., Rationale for the recommendations for harmonizing current methodology for detecting BCR-ABL transcripts in patients with chronic myeloid leukaemia (2006) Leukemia, 20 (11), pp. 1925-1930Cortes, J., Baccarani, M., Fea, G., (2008) A Phase III, Randomized, Openlabel Study of 400 Mg Versus 800 Mg of Imatinib Mesylate (IM) in Patients With Newly Diagnosed, Previously Untreated Chronic Myeloid Leukemia in Chronic Phase (CML-CP), Using Molecular Endpoints: One Year Results of TOPS (Tyrosine Kinase Inhibitor Optimization and Selectivity) Study, , 50th ASH Annual Meeting and Exposition Online program and Abstracts. San Francisco, CABranford, S., Fletcher, L., Cross, N.C., Muller, M.C., Hochhaus, A., Kim, D.W., Desirable performance characteristics for BCR-ABL measurement on an international reporting scale to allow consistent interpretation of individual patient response and comparison of response rates between clinical trials (2008) Blood, 112 (8), pp. 3330-3338O'Brien, S.G., Guilhot, F., Larson, R.A., Gathmann, I., Baccarani, M., Cervantes, F., Imatinib compared with interferon and lowdose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia (2003) N Engl J Med, 348 (11), pp. 994-1004Marin, D., Milojkovic, D., Olavarria, E., Khorashad, J.S., de Lavallade, H., Reid, A.G., European LeukemiaNet criteria for failure or suboptimal response reliably identify patients with CML in early chronic phase treated with imatinib whose eventual outcome is poor (2008) Blood, 112 (12), pp. 4437-444

Concomitant essential thrombocythemia with jak2 v617f mutation in a patient with chronic myeloid leukemia with major molecular response with imatinib and long-term follow-up

The association of chronic myeloid leukemia (CML) with other myeloproliferative neoplasms (MPNs), in particular with the V617F mutation in the Janus kinase 2 (JAK2) gene, is very uncommon, and there are only a few cases reported in the literature. In the present study, the case of a 73-year-old man with CML and persistent thrombocytosis, is reported. The patient achieved a complete cytogenetic response and major molecular response (MR) with imatinib. The patient presented JAK2 V617F mutation, and bone marrow morphology was consistent with essential thrombocythemia. The patient was treated with imatinib and hydroxyurea to control the platelet count, and maintains complete MR with imatinib upon 10 years of follow-up. Although rare, the association of breakpoint cluster region-Abelson rearrangement and JAK2 V617F mutation should be investigated in patients with MPN, since both genetic anomalies may be present at diagnosis or may emerge during treatment, and require different therapeutic approaches.The association of chronic myeloid leukemia (CML) with other myeloproliferative neoplasms (MPNs), in particular with the V617F mutation in the Janus kinase 2 (JAK2) gene, is very uncommon, and there are only a few cases reported in the literature. In the121485487sem informaçãosem informaçã

De Nanterre a Vincennes. La universidad francesa y el Mayo del 68

L’objectiu d’aquest article està centrat fonamentalment en els aspectes més problemàtics que va patir la universitat francesa durant el procés de Reforma que el govern del general Charles De Gaulle es va veure obligat a posar en marxa pels esdeveniments de maig de 1968. Però la «revolta dels estudiants» va estar condicionada des de molt abans per un sistema educatiu les estructures del qual estaven en total decadència. La Llei d’Orientació aprovada aquell mateix any ni va solucionar els conflictes que feia anys arrossegava la universitat ni va subministrar a la comunitat educativa un projecte de futur amb garanties de llibertat acadèmica. Els exemples de dues universitats com la de Nanterre, nucli central de la revolta, i la de Vincennes, un projecte educatiu fracassat de la França post-revolucionària, són la mostra de la dificultat que tota reforma universitària comporta més enllà de les urgències que històricament la fan necessària. _____________________________________________ Cet article est centré pour l’essentiel sur les aspects les plus problématiques dont a souffert l’Université française durant le processus de réforme que le gouvernement du général de Gaulle s’est vu obligé de mettre en oeuvre après les événements de mai 68. Mais, la « révolte des étudiants » avait été conditionnée depuis bien longtemps par un système éducatif dont les structures étaient en profonde décadence. La Loi d’Orientation approuvée cette même année n’a pas apporté de solution aux conflits que l’Université traînait depuis des années, pas davantage qu’elle n’a fourni à la communauté éducative un projet d’avenir présentant des garanties de liberté académique. Les exemples de deux universités, Nanterre, noyau central de la révolte, et Vincennes, projet éducatif avorté de la France « post-révolutionnaire », sont la preuve de la difficulté que toute réforme universitaire comporte bien au-delà des urgences qui la rendent historiquement nécessaire.The objectives of this article focus principally on the most controversial aspects of what happened to the French university system during the period of reform which General Charles De Gaulle felt obliged to implement after the events of May 1968. Long before the “student revolt”, however, the structures of the educational system had fallen into decadence. The Law of Orientation, which was passed in 1968, failed to solve the deeper conflicts that had been plaguing the university system for years. Nor did it provide the educational community with a project for the future built on guarantees of academic freedom. Two universities are offered as examples: Nanterre, which lay at the core of the student revolt, and Vincennes, a failed educational project of “post-revolutionary” France. Together, they provide a sample of the difficulties faced by any university reform in reaching beyond the urgent conditions that make it historically necessary.El objetivo de este artículo es analizar los aspectos más problemáticos que afectaron a la universidad francesa durante el proceso de Reforma que el gobierno del general Charles De Gaulle se vio obligado a poner en marcha a causa de los sucesos de mayo de 1968. Pero la «revuelta de los estudiantes» estuvo condicionada desde mucho tiempo atrás por un sistema educativo cuyas estructuras estaban en total decadencia. La Ley de Orientación Universitaria aprobada aquel mismo año ni solucionó los conflictos que hacía años arrastraba la universidad ni suministró a la comunidad educativa un proyecto de futuro con garantías de libertad académica. Los ejemplos de dos universidades como la de Nanterre, núcleo central de la revuelta, y la de Vincennes, un proyecto educativo fracasado de la Francia «post-revolucionaria», son la muestra de la dificultad que toda reforma universitaria conlleva más allá de las urgencias que históricamente la hacen necesaria

3-Aroyl-1,4-diarylpyrroles inhibit chronic myeloid leukemia cell growth through an interaction with tubulin

We designed 3-aroyl-1,4-diarylpyrrole (ARDAP) derivatives as potential anticancer agents having different substituents at the 1- or 4-phenyl ring. ARDAP compounds exhibited potent inhibition of tubulin polymerization, binding of colchicine to tubulin, and cancer cell growth. ARDAP derivative 10 inhibited the proliferation of BCR/ABL-expressing KU812 and LAMA84 cells from chronic myeloid leukemia (CML) patients in blast crisis and of hematopoietic cells ectopically expressing the imatinib mesylate (IM)-sensitive KBM5-WT or its IM-resistant KBM5-T315I mutation. Compound 10 minimally affected the proliferation of normal blood cells, indicating that it may be a promising agent to overcome broad tyrosine kinase inhibitor resistance in relapsed/refractory CML patients. Compound 10 significantly decreased CML proliferation by inducing G2/M phase arrest and apoptosis via a mitochondria-dependent pathway. ARDAP 10 augmented the cytotoxic effects of IM in human CML cells. Compound 10 represents a robust lead compound to develop tubulin inhibitors with potential as novel treatments for CML

Low educational level but not low income impairs the achievement of cytogenetic remission in chronic myeloid leukemia patients treated with imatinib in Brazil

OBJECTIVES: In Brazil, imatinib mesylate is supplied as the first-line therapy for chronic myeloid leukemia in the chronic phase through the public universal healthcare program, Sistema Único de Saúde (SUS). We studied the socio-demographic factors that influenced therapy success in a population in the northeast region of Brazil. METHODS: Patients with chronic myeloid leukemia from the state of Piauí were treated in only one reference center. Diagnosis was based on WHO 2008 criteria. Risk was assessed by Sokal, Hasford and EUTOS scores. Patients received 400 mg imatinib daily. We studied the influence of the following factors on the achievement of complete cytogenetic response within one year of treatment: age, clinical risk category, time interval between diagnosis and the start of imatinib treatment, geographic distance from the patient's home to the hospital, years of formal education and monthly income. RESULTS: Among 103 patients studied, the median age was 42 years; 65% of the patients had 2-9 years of formal education, and the median monthly income was approximately 100 US$. Imatinib was started in the first year after diagnosis (early chronic phase) in 69 patients. After 12 months of treatment, 68 patients had a complete cytogenetic response. The Hasford score, delay to start imatinib and years of formal education influenced the attainment of a complete cytogenetic response, whereas income and the distance from the home to the healthcare facility did not. CONCLUSION: Patients require additional healthcare information to better understand the importance of long-term oral anticancer treatment and to improve their compliance with the treatment