Digital PCR improves the quantitation of DMR and the selection of CML candidates to TKIs discontinuation

  • Simona Bernardi
    Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences University of Brescia, ASST Spedali Civili di Brescia Brescia Italy
  • Michele Malagola
    Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences University of Brescia, ASST Spedali Civili di Brescia Brescia Italy
  • Camilla Zanaglio
    Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences University of Brescia, ASST Spedali Civili di Brescia Brescia Italy
  • Nicola Polverelli
    Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences University of Brescia, ASST Spedali Civili di Brescia Brescia Italy
  • Elif Dereli Eke
    Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences University of Brescia, ASST Spedali Civili di Brescia Brescia Italy
  • Mariella D’Adda
    Division of Hematology ASST Spedali Civili of Brescia Brescia Italy
  • Mirko Farina
    Division of Hematology ASST Spedali Civili of Brescia Brescia Italy
  • Cristina Bucelli
    Hematology Division Foundation IRCCS Ca' Granda‐Ospedale Maggiore Policlinico Milan Italy
  • Luigi Scaffidi
    Department of Medicine, Section of Hematology University of Verona Verona Italy
  • Eleonora Toffoletti
    Division of Hematology and Bone Marrow Transplantation, Department of Medical Area University of Udine Udine Italy
  • Clara Deambrogi
    Division of Hematology, Department of Translational Medicine University of Eastern Piedmont Novara Italy
  • Fabio Stagno
    Hematology Section and BMT Unit Rodolico Hospital A.O.U. Policlinico – V. Emanuele Catania Italy
  • Micaela Bergamaschi
    Clinical Hematology, Dipartimento Terapie Oncologiche Integrate Ospedale Policlinico San Martino Genova Italy
  • Luca Franceschini
    Department of Biomedicine and Prevention The University Tor Vergata Rome Italy
  • Elisabetta Abruzzese
    Division of Hematology S. Eugenio Hospital Roma Italy
  • Maria Domenica Divona
    Department of Biomedicine and Prevention The University Tor Vergata Rome Italy
  • Marco Gobbi
    Clinical Hematology, Dipartimento Terapie Oncologiche Integrate Ospedale Policlinico San Martino Genova Italy
  • Francesco Di Raimondo
    Hematology Section and BMT Unit Rodolico Hospital A.O.U. Policlinico – V. Emanuele Catania Italy
  • Gianluca Gaidano
    Division of Hematology, Department of Translational Medicine University of Eastern Piedmont Novara Italy
  • Mario Tiribelli
    Division of Hematology and Bone Marrow Transplantation, Department of Medical Area University of Udine Udine Italy
  • Massimiliano Bonifacio
    Department of Medicine, Section of Hematology University of Verona Verona Italy
  • Chiara Cattaneo
    Division of Hematology ASST Spedali Civili of Brescia Brescia Italy
  • Alessandra Iurlo
    Hematology Division Foundation IRCCS Ca' Granda‐Ospedale Maggiore Policlinico Milan Italy
  • Domenico Russo
    Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences University of Brescia, ASST Spedali Civili di Brescia Brescia Italy

抄録

<jats:title>Abstract</jats:title><jats:p>Treatment‐free remission (TFR) by tyrosine kinase inhibitors (TKI) discontinuation in patients with deep molecular response (DMR) is a paramount goal in the current chronic myeloid leukemia (CML) therapeutic strategy. The best DMR level by real‐time quantitative PCR (RT‐qPCR) for TKI discontinuation is still a matter of debate. To compare the accuracy of digital PCR (dPCR) and RT‐qPCR for <jats:italic>BCR‐ABL1</jats:italic> transcript levels detection, 142 CML patients were monitored for a median time of 24 months. Digital PCR detected <jats:italic>BCR‐ABL1 </jats:italic>transcripts in the RT‐qPCR undetectable cases. The dPCR analysis of the samples, grouped by the MR classes, revealed a significant difference between MR<jats:sup>4.0</jats:sup> and MR<jats:sup>4.5</jats:sup> (<jats:italic>P</jats:italic> = 0.0104) or MR<jats:sup>5.0</jats:sup> (<jats:italic>P</jats:italic> = 0.0032). The clinical and hematological characteristics of the patients grouped according to DMR classes (MR<jats:sup>4.0</jats:sup> vs MR<jats:sup>4.5‐5.0</jats:sup>) were superimposable. Conversely, patients with dPCR values <0.468 <jats:italic>BCR‐ABL1</jats:italic> copies/µL (as we previously described) showed a longer DMR duration (<jats:italic>P</jats:italic> = 0.0220) and mainly belonged to MR<jats:sup>4.5‐5.0</jats:sup> (<jats:italic>P</jats:italic> = 0.0442) classes compared to patients with higher dPCR values. Among the 142 patients, 111 (78%) discontinued the TKI treatment; among the 111 patients, 24 (22%) lost the MR<jats:sup>3.0 </jats:sup>or MR<jats:sup>4.0</jats:sup>. RT‐qPCR was not able to discriminate patients with higher risk of MR loss after discontinuation (<jats:italic>P</jats:italic> = 0.8100). On the contrary, according to dPCR, 12/25 (48%) patients with <jats:italic>BCR‐ABL1</jats:italic> values ≥0.468 and 12/86 (14%) patients with <jats:italic>BCR‐ABL1</jats:italic> values <0.468 lost DMR in this cohort, respectively (<jats:italic>P</jats:italic> = 0.0003). Treatment‐free remission of patients who discontinued TKI with a dPCR <0.468 was significantly higher compared to patients with dPCR ≥ 0.468 (TFR at 2 years 83% vs 52% <jats:italic>P</jats:italic> = 0.0017, respectively). In conclusion, dPCR resulted in an improved recognition of stable DMR and of candidates to TKI discontinuation.</jats:p>

収録刊行物

被引用文献 (2)*注記

もっと見る

問題の指摘

ページトップへ