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Appearance of bone marrow lymphocytosis predicts an optimal response to imatinib therapy in patients with chronic myeloid leukemia

Leukemia volume 21, pages 2363–2368 (2007)Cite this article

Chronic myeloid leukemia (CML) is a malignant hematopoietic stem cell disorder. It is characterized by the presence of the Philadelphia (Ph) chromosome, which contains the chimeric BCR-ABL fusion gene encoding a constitutively active tyrosine kinase. Targeted inhibition of BCR-ABL kinase protein by imatinib (Glivec), a tyrosine kinase inhibitor, induces complete cytogenetic response (CCR) in 70–90% of chronic-phase CML patients with minute side effects,1 and is the drug of choice for all newly diagnosed CML patients.

Imatinib therapy is regarded lifelong, as rapid disease relapse has been reported in several case reports upon drug discontinuation. However, in a small proportion of patients with a very low level of minimal residual disease, imatinib discontinuation may be feasible.2 The mechanisms behind this ‘operational cure’ are unknown, but can be related to anti-CML immunity, possibly induced by the preceding interferon (IFN) α therapy in these patients. However, imatinib may also have immunomodulatory properties, which can be important in the long-term control of CML. In patients relapsing after allogeneic stem cell transplantation, imatinib has an additive effect on donor lymphocyte infusions in inducing remissions, and it restores the dendritic cell function important in the recognition of tumor cells in vitro and in vivo.

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Acknowledgements

Dr S Siitonen is acknowledged for the valuable help with the flow cytometry and the laboratory technicians in the Laboratory of Hematology, HUSLAB are acknowledged for their expert technical assistance. This work was supported by the Finnish special governmental subsidy for health sciences, research and training, The Signe and Ane Gyllenberg foundation, and the Finnish Cancer Organizations.

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Authors and Affiliations

  1. Hematology Research Unit, Biomedicum Helsinki, Helsinki University Central Hospital, Helsinki, Finland

    S Mustjoki, T Lundán & K Porkka

  2. Department of Clinical Chemistry, HUSLAB, Laboratory of Hematology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland

    S Mustjoki

  3. Department of Pathology, HUSLAB and Haartman Institute, University of Helsinki, Helsinki, Finland

    T Lundán & S Knuutila

  4. Department of Medicine, Division of Hematology, Helsinki University Central Hospital, Helsinki, Finland

    K Porkka

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  1. S Mustjoki
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  2. T Lundán
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Correspondence to S Mustjoki.

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Supplementary Information accompanies the paper on the Leukemia website (http://www.nature.com/leu)

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Mustjoki, S., Lundán, T., Knuutila, S. et al. Appearance of bone marrow lymphocytosis predicts an optimal response to imatinib therapy in patients with chronic myeloid leukemia. Leukemia 21, 2363–2368 (2007). https://doi.org/10.1038/sj.leu.2404807

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