ALBERT

Description: The BCR-ABL targeted therapy using ImatinibMesylate (IM) is considered the standard care in chronic myeloid leukemia (CML) management. Despite shown to produce superior results, up to 33% of CML patients on IM therapy, develop resistance which can be either BCR-ABLdependent (gene amplification or point mutations of BCR-ABL gene) or BCR-ABL independent. We undertook molecular, epigenetic and pharmacogenetic approaches to elucidate the heterogeneous array of mechanisms of resistance in Malaysian CML patients undergoing IM therapy. Using denaturing High Performance Liquid Chromatography followed by sequencing 122IM resistant CML patients were screened for BCR-ABL mutations. As part of epigenetic approach, 175 CML patients comprising of 83 good response and 92 BCR-ABL non mutated IM resistant CML patients were subjected to Methylation Specific High Resolution Melt Analysis (MS-HRM) to quantitate the promoter methylation level of HOXA4 and HOXA5 genes. For pharmacogenetic study, 215 CML patients consisting of 107 IM good response and 108 IM resistant CML patients were genotyped for polymorphisms in ABCB1 (1236 T〉C, 2677 G〉T/A, 3435 C〉T), ABCG2 (34 G〉A, 421 C〉A), ABCC1 (2012 G〉T, 2168 C〉A), ABCC2 (-24 C〉T, 1249 G〉A, 3972 C〉T), SLC22A1 (480 C〉G, 1201 G〉A, 1222 G〉A, 1239 G〉A, 1258-1260 ATG del, TGGTAAGT 8+/8- ins/del), PXR (1792 A〉G) and CYP3A4 (878 T〉C) genes using polymerase chain reaction restriction fragment length polymorphism technique. BCR-ABL mutations were detected in 30/122 patients (24.6%). Seventeen different types of mutations (T315I, G250E, E255K, E255V, M351T, Y253H, V289F, E355G, F359V, L387M, H396R, E355A, D276G, A397P and E281K) including 2 novel mutations (G251E and N368S) were identified in varying frequencies.Detection of mutations during course of IM therapy may aid in risk stratification as well as in determining therapeutic strategies. MS-HRM analysis showed varying hypermethylation levels of HOXA4 and HOXA5 genes in CML patients studied. IM treated CML patients with higher than 62.5% of HOXA4 methylation were found to be associated with a higher risk for developing IM resistance (OR 4.71; 95% CI: 2.46-9.03; p