Transcriptomics

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Gene expression signature that predicts early molecular response failure in chronic phase CML patients on frontline imatinib


ABSTRACT: In chronic phase chronic myeloid leukemia (CP-CML) patients treated with frontline imatinib, failure to achieve early molecular response (EMR failure: BCR-ABL1 >10% (IS) at 3 months) is predictive of inferior outcomes. Identifying patients at high-risk of EMR failure at diagnosis provides an opportunity to intensify frontline therapy and potentially avoid EMR failure. We studied blood samples from 96 CP-CML patients at diagnosis and identified 365 genes that were aberrantly expressed in 13 patients who subsequently failed to achieve EMR, with a gene signature significantly enriched for stem cell phenotype (e.g. Myc, b-catenin, Hoxa9/Meis1), cell cycle, and reduced immune response pathways. We selected a 17-gene panel to predict EMR failure and validated this signature on an independent patient cohort. Patients classified as high-risk with our gene expression signature (HR-GES) exhibited significantly higher rates of EMR failure compared to low-risk (LR-GES) patients (78% vs 5%; p<0.0001) with an overall accuracy of 93%. Furthermore, HR-GES patients who received frontline nilotinib had a relatively low rate of EMR failure (10%). However HR-GES patients still had inferior deep molecular response achievement rate by 24 months compared to LR-GES patients. This novel multi-gene signature may be useful for selecting patients at high risk of EMR failure on standard therapy, who may benefit from trials of more potent kinase inhibitors or other experimental approaches.

ORGANISM(S): Homo sapiens

PROVIDER: GSE130404 | GEO | 2019/05/29

REPOSITORIES: GEO

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