Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/115681
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Type: Journal article
Title: ASXL1 and BIM germ line variants predict response and identify CML patients with the greatest risk of imatinib failure
Author: Marum, J.
Yeung, D.
Purins, L.
Reynolds, J.
Parker, W.
Stangl, D.
Wang, P.
Price, D.
Tuke, J.
Schreiber, A.
Scott, H.
Hughes, T.
Branford, S.
Citation: Blood Advances, 2017; 1(18):1369-1381
Publisher: American Society of Hematology
Issue Date: 2017
ISSN: 2473-9529
2473-9537
Statement of
Responsibility: 
David T. Yeung … Jonathan Tuke, Andreas W. Schreiber, Hamish S. Scott, Timothy P. Hughes, Susan Branford … et al.
Abstract: Scoring systems used at diagnosis of chronic myeloid leukemia (CML), such as Sokal risk, provide important response prediction for patients treated with imatinib. However, the sensitivity and specificity of scoring systems could be enhanced for improved identification of patients with the highest risk. We aimed to identify genomic predictive biomarkers of imatinib response at diagnosis to aid selection of first-line therapy. Targeted amplicon sequencing was performed to determine the germ line variant profile in 517 and 79 patients treated with first-line imatinib and nilotinib, respectively. The Sokal score and ASXL1 rs4911231 and BIM rs686952 variants were independent predictors of early molecular response (MR), major MR, deep MRs (MR4 and MR4.5), and failure-free survival (FFS) with imatinib treatment. In contrast, the ASXL1 and BIM variants did not consistently predict MR or FFS with nilotinib treatment. In the imatinib-treated cohort, neither Sokal or the ASXL1 and BIM variants predicted overall survival (OS) or progression to accelerated phase or blast crisis (AP/BC). The Sokal risk score was combined with the ASXL1 and BIM variants in a classification tree model to predict imatinib response. The model distinguished an ultra-high-risk group, representing 10% of patients, that predicted inferior OS (88% vs 97%; P = .041), progression to AP/BC (12% vs 1%; P = .034), FFS (P < .001), and MRs (P < .001). The ultra-high-risk patients may be candidates for more potent or combination first-line therapy. These data suggest that germ line genetic variation contributes to the heterogeneity of response to imatinib and may contribute to a prognostic risk score that allows early optimization of therapy.
Rights: © 2017 by The American Society of Hematology
RMID: 0030075385
DOI: 10.1182/bloodadvances.2017006825
Grant ID: http://purl.org/au-research/grants/nhmrc/1059165
http://purl.org/au-research/grants/nhmrc/1104425
http://purl.org/au-research/grants/nhmrc/1023059
Appears in Collections:Molecular and Biomedical Science publications

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