Physiopathology and treatment ofchronic myeloid leukemia: new concepts and perspectives

Authors

  • Bernardo Garicochea Médico Assistente. Faculdade de Medicina. Universidade de São Paulo (USP). São Paulo (SP), Brasil
  • Pedro Enrique Dorlhíac-Llacer Diretor Técnico-Científico da Fundação Hemocentro de São Paulo. São Paulo (SP), Brasil

DOI:

https://doi.org/10.32635/2176-9745.RBC.1996v42n2.2894

Keywords:

Chronic Myelogenous Leucemia, Philadelphia Chromossome, BCR/ABL Translocation, Bone Marrow Transplantation, Alpha-Interferon

Abstract

Recent breakthroughs on the functional activity ofthe BCR/ABL chimeric gene translated in further insights on the genesis and progression of chronic myeloloid leukemia (CML). Despite CML still is an incumble disease for those patients not eligible for a bone marrow transplant, the overall survival is progressively increasing specially because of prolongation of chronic phase. PCR for BCR/ABL gene is proving a valuable tool in identifying Ph-patients who present the rearrangement at molecular level and to detect minimal residual disease specially in transplanted patients. New forms of treatment might translate in survival gain in the next years mainly when used at early stages of the disease: autologous stem cell transplant (ASCT) with cells mobilised and collected after high dose chemotherapy; the use of interferon and genetherapy. Interferon is already the principal choice of treatment for the majority of the cases. ASCT is a promising procedure and has been used in many institutions as an alternative to allo-BMT. Results of different approaches of genetherapy are disappointing so far, but the improvement of technology in this field will be of most interest in treating CML considering the ubiquitous and functional role of the BCR/ABL gene in the malignant cells.

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References

Nowell, P.C.; Flungerford, D. A. - A minute chromosone in human chronic granulocytic leukemia, Science, 132: 1497, 1960.

Rowley, J.D. - A new consistent chromosomal abnormality in chronic myelogenous leukemia identified by quinacrine fluorescence and Giemsa staining. Nature, 243: 290-293, 1973.

Heisterskamp, N.; Stephenson, J.R.; Groffen, J.; Hansen, P.; De Klein, F.; Bartram, C.R.; Grosveld, G. - Localization of the C-ABL oncogene adjacent to a translocation breakpoint in chronic myelocytic leukemia. Nature, 306: 239-242, 1983. DOI: https://doi.org/10.1038/306239a0

Heisterkamp, N.; Jenster, G.; TenHoeve, J.; Zovich, D.; Patengale, P.K.; Groffen, J. - Acute leukemia in bcr/abl transgenic mice. Nature, 344: 251-253, 1990. DOI: https://doi.org/10.1038/344251a0

Guerrasio, A.; Martinelli, G.; Saglio, G.; Rosso, C.; Zaccaria A.; Rosti, G.; Testoni, N.; Ambrosetti, A.; Izzi, T.; Sessarego, M.; Frassoni, F.; Gasparini, P.; Chiamenti. A.; Di Bartolomeo, A.; Pignatti, P.F. - Minimal residual disease status in transplanted chronic myelogenous leukemia patients: low incidence of polymerase chain reaction positive cases among 48 long disease-free subjects who received unmanipulated allogenic bone marrow transplants. Leukemia 6: 507-512, 1992.

Arnold, R.; Janssen, J.W.G.; Heize, B.; Bunjes, D.; Herteistein, B.; Wiesneth, M.; KubanekB.; Fleimpel H.; Bartram, C.R. - Influence of graft-versus-host disease on the eradication of minimal residual leukemia detected by polymerase chain reaction in chronic myeloid leukemia patients after bone marrow transplantation. Leukemia, 7: 47-751, 1993.

Yinon, B.N.; Daley, G.Q.; Mes-Masson, A.M.; Witte, O.N.; Baltimore, D. -The chronic myelogenous leukemia-specific p210 protein is the product of the BCR/ABL hybrid gene. Science, 233: 212-214, 1986. DOI: https://doi.org/10.1126/science.3460176

Clarkson, B.; Strife, A. - Linkage of proliferative and maturational abnormalities in chronic myelogenous leukemia and relevance to treatment. Leukemia, 7: 1683-1721, 1993.

McGahon, A.; Bissonette, R.; Schmitt, M.; Cotter, K.M.; Green, D.R.; Cotter, T.G. - BCR-ABL mantains resistance of chronic myelogenous leukemia cells to apoptotic cell death. Blood, 83: 1179-1187,1994. DOI: https://doi.org/10.1182/blood.V83.5.1179.1179

Wetzler M.; Talpaz M.; Yee, G.; Stass, A.S.;Van Etten,R.A.;Andreef,M.;Goodacre, A. M.; Kleine, H-D.; Mahadevia, R-K.; Kuzrock, R. - Cell cycle-related shifts in subcellular localization of BCR: Association with mitotic chromosomes and with heterochromatin. Blood, 84: 1391, 1994.

Witte, O.N. - Role of the BCR-ABL oncogene in human leukemia: fifteenth Richard and Hinda Rosenthal Foundation Award Lecture. CancerRes, 53: 485, 1993.

Goga, A.; McLaughlin,J.; Afar, D.E.Fl.; Saffran, D.C.; Witte, O.N. – Altemative signals to RAS for hematopoietic transformation hy the BCR-ABL oncogene. Cell, 82.-981, 1995. DOI: https://doi.org/10.1016/0092-8674(95)90277-5

Fialkow, P.J.; Gartler, S.M.; Yoshida, A. - Clonal origin in chronic myelocytic leukemia in man. Proc natl Acad Sci USA, 58: 1468,1987. DOI: https://doi.org/10.1073/pnas.58.4.1468

Fialkow, P.J.; Martin P.J.; Najfeld, V.; Penfold, G.F.; Jacohsen, R.J.; Hansen, J.A. - Evidence for a multistep pathogenesis for chronic myeloid leukemia. Blood, 58: 158, 1981. DOI: https://doi.org/10.1182/blood.V58.1.158.bloodjournal581158

Goldman, J.M.; Shiota, F.;Th’ng,K.H. - Circulating granulocytes and erythroid progenitor cells in chronic granulocyt leukemia. Br J Haematol, 46: 7, 1980. DOI: https://doi.org/10.1111/j.1365-2141.1980.tb05929.x

Duhé, I.D.; Kalousek, D.; Coulomhel, I. - Cytogenetic studies in early myeloid progenitor compartments in Phl - positive chronic myeloid leukemia. II. Long term culture reveals the persistence of Ph I -negative progenitors in treated as well as newly diagnosed pa-tients. B/ooJ, 63: 1172, 1984. DOI: https://doi.org/10.1182/blood.V63.5.1172.1172

Fialkow, P.J.; Jacohson, R.J.; Papayannopoulou, T. - chronic myelocytic leukemia. Clonal origin in a stem cell common to the granulocyte, eyrthrocyte, platelet and monocyte/macrophage. Am J Med, 63: 125, 1977. DOI: https://doi.org/10.1016/0002-9343(77)90124-3

Garicochea, B.; Chase, A.; Lazaridou, A.; Goldman, J.M. - T-lymphocytes in CML: No evidence of the BCR/ABL fusion gene detected hy fluorescence in situ hybridization. Leukemia, 8: 1197, 1994.

Bernstein, I.; Singer, J.; Smith, F.; Andrews, R.; Flowers, D.; Petersens, J.; Steinmann, N.; Najfeld, V.; Savage, D.; Fruchtman, S.; Arlin, Z.; Fialkow, P. - Differences in the frequency of normal and clonal precursors of colony-forming cells in chronic myelogenous leukemia and acute myelogenous leucemia. Blood, 79: 1811, 1992. DOI: https://doi.org/10.1182/blood.V79.7.1811.bloodjournal7971811

Pichert, G.; Alyea, E.P.; Soiffer, R.J.; Roy, D.C.; Ritz, J. - Persistence of myeloid progenitor cells expressing BCR/ABL mRNA after allogenic bone marrow transplantation for chronic myelogenous leukemia. Blood, 84: 2109, 1994. DOI: https://doi.org/10.1182/blood.V84.7.2109.bloodjournal8472109

Serra, A.; Guerrasio, A.; Gaidano, G.; Rosso, C.; Rege-Camhrin, G.; Petroni, D.; Mazza, U.; Saglio, G. – Molecular defects associated with the acute phase CML. Leukemia Lymphoma, II (supl I): 25, 1993. DOI: https://doi.org/10.3109/10428199309047858

Ahuja, H.G.;Bar-Eli,M.;Advani,S.H.; Benshimol, S.; Cline, M.J. - Alterations in the p53 gene and the clonal evolution of the hlast crisis of chronic myelocytic leukemia. Proc Natl Acad Sci USA, 86: 6783, 1989. DOI: https://doi.org/10.1073/pnas.86.17.6783

Sill, H.; Goldman, J.M.; Cross, N.C.P. - Homozygous deletions of the p 16 tumor-supressor gene are associated with lymphoid transformation of chronic myeloid leukemia. Blood, 85: 2013. DOI: https://doi.org/10.1182/blood.V85.8.2013.bloodjournal8582013

Nakai, H.; Misawa, S.; Horiike, S.; Taniwake, M.; Seriu, T.; Shimazaki, C.; Fujii, H.; Maekawa, T.; Furukawa, T.; Ahe, T.; Ishizaki, K.; Kashima, K. - Analysis of mutations and expression of GAP-related domain of neurofihromatosis type 1 (NFl) gene in the progression of chronic myelogenous leukemia. Leukemia, 8: 1994, 1027.

Wetzler, M.; Talpaz, M.; Estrov, Z.; Kurzrock, R. - CML mechanisms of disease initiation and progression. Leukemia Lymphoma, 11:1993, suppl 1,47. DOI: https://doi.org/10.3109/10428199309047863

Bendit, 1.; Garicochea B.; Manzella, L.; Dorlhiac-Llacer, P.E.; Chamone, D.A.F.; Bydlowski, S.P. – Neurofibromatosis type 1 (NFl) mutational analysis by PCR-SSCP in chronic myelogenous leukemia in chronic phase and blast crisis. Acta Haematol, 93: 180, 1995.

Sawyers, C.L.; Callahan, W.; Witte, O.N. - Dominant negative MYC blocks transformation by ABL oncogenes. Cell, 70: 901, 1992. DOI: https://doi.org/10.1016/0092-8674(92)90241-4

Alimena, G.; Brandt, L.; Dallapiccola, B.; Mitelman, F.; Milsson, P.G. - Secondary chromosome changes in chronic myeloid leukemia: Relation to treatment. Cancer Genet Gytogenet, 1: 79, 1979. DOI: https://doi.org/10.1016/0165-4608(79)90013-X

Dobrovic, A.; Trainor, K.J.; Morley, A.A. - Detection of the molecular abnormality in chronic myeloid leukemia by use of the polimerase chain reaction. Blood, 72: 2063, 1988. DOI: https://doi.org/10.1182/blood.V72.6.2063.2063

Rowley, J.D. - A consistent chromosomal abnormality in chronic myelogenous leukaemia identified by quinacrine fluorescence and Giemsa staining. Nature, 243: 290, 1973. DOI: https://doi.org/10.1038/243290a0

Kantarjian, H.M.; Deisseroth, A.; Kurzrock, R.; Estrov, E.; Talpaz, M. - Chronic myelogenous leukemia: A concise update. Blood, 82: 691, 1993. DOI: https://doi.org/10.1182/blood.V82.3.691.691

Saglio, G.; Guerrasio, A.; Tassinari, A.; Ponzetto, C.; Zaccaria, A.; Testoni, P.; Celso, B.; Rege Cambrin, G.; Serra, A.; Pegoraro, L.; Avanzi, G.C.; Attadia, V.; Ealda, M.; Gavosto, E. - Variability of the molecular defects corresponding to the presence of a Philadelphia chromosome in human hematologic malignancies. Blood, 72: 1203, 1988. DOI: https://doi.org/10.1182/blood.V72.4.1203.bloodjournal7241203

Crist, W.; Carrol, A.; Shuster, J.; Jackson, J.; Head, D.; Borowitz, M.; Behm, F.; Link, M.; Steuber, P.; Ragah, A.; Hirt, A.; Brock, B.; Land, V.; Pullen, J. - Philadelphia chromosome positive childhood acute lymphoblastic leukemia: Clinical and cytogenetic characteristics and treatment outcome. A pediatric oncology group study. Blood, 76: 498, 1990. DOI: https://doi.org/10.1182/blood.V76.3.489.489

Hughes, T.P.; Morgan, G.J.; Martia, P.; Goldman, J.M. - Detection of residual leukemia after bone marrow transplant for chronic myeloid leukemia: Role of the polymerase chain reaction in predicting relapse. Blood, 77: 874, 1991. DOI: https://doi.org/10.1182/blood.V77.4.874.bloodjournal774874

Cross, N.C.P.; Feng, L.; Chase, A.; Bungey, J.; Hughes, T.P.; Goldman, J.M. - Competitive polymerase chain reaction to estimate the number of BCR/ABL transcripts in chronic myeloid leukemia patients after bone marrow transplantation. Blood, 82: 1929, 1993. DOI: https://doi.org/10.1182/blood.V82.6.1929.bloodjournal8261929

Baccarini, M. - For the Italian Cooperative Study Group on Chronic Myeloid Leukemia: Evaluating survival after allogenic bone marrow transplant for chronic myeloid leukemia in chronic phase: A comparison of transplant versus no-transplant in a cohort of 258 patients first seen in Italy between 1984 and 1986. Br J Haematol, 85: 292, 1993. DOI: https://doi.org/10.1111/j.1365-2141.1993.tb03169.x

Goldman, J.M. - The treatment of chronic myeloid leukaemia - much still to be achieved. J Intem Med 1994; 235: 289. DOI: https://doi.org/10.1111/j.1365-2796.1994.tb01078.x

Allen, S.L.; Coleman, M. - Terminal-phase chronic myelogenous leukemia: Approaches to treatment. Cancer Invesl, 3.-491, 1985. DOI: https://doi.org/10.3109/07357908509039811

Kantarjian, H.M.; Keating, M.J.; Estey, E.H.; 0’Brien, S.; Pierce, S.; Beran, M.; Koller, C.; Eeldman, E.; Talpaz, M. - Treatment of advanced stages of Philadelphia chromosome-positive chronic myelogenous leukemia with interferon-a and low-dose cytarabine. J Clin Oncol, 10: 772, 1992. DOI: https://doi.org/10.1200/JCO.1992.10.5.772

Hehlmann, R.; Heimpel, H.; Hasford, J.; Kolb, H.J.; Pralle, H.; Hossfeld, D.K. et al. - Randomized comparison of busulphan and hydroxyurea in chronic myelogenous leukemia: Prolongation survival by hydroxyurea. Blood, 82: 398, 1993. DOI: https://doi.org/10.1182/blood.V82.2.398.bloodjournal822398

Alimena, G.; Morra, E.; Lazzarino, M. et al. - Interferon Alpha 2b as therapy for Phl-positive chronic myelogenous leukemia. A study of 82 patients treated with intermittent or daily administration. Blood, 72.-642, 1988. DOI: https://doi.org/10.1182/blood.V72.2.642.642

Lee, M-S.; Kantarjian, H.; Talpaz, M.; Freireich, E.J.; Deissroth, A.; Trujillo, J.M.; Stass, S.A. - Detection of minimal residual disease by polimerase chain reaction in Philadelphia chromosome-positive myelogenous leucemia following interferon therapy. Blood, 79: 1920, 1992. DOI: https://doi.org/10.1182/blood.V79.8.1920.bloodjournal7981920

Ronnblom, L.E.; Alm, E.V.; Oberg, K.E. - Autoimmunity after alpha-interpheron therapy for malignant carcinoid tumors. Ann Intern Med, 115: 178, 1991. DOI: https://doi.org/10.7326/0003-4819-115-3-178

Hehlmann, R.; Heimpel, H.; Hasford, J.; Kolb, H.J.; Pralle, H.; Hossfeld, D.K.; Queisser, W.; Loffler, H.; Ho-chhaus. A.; Heinze, B.; Ansari, H. and the German CML study group - Randomized comparision of interferon-alfa with busulfan and hydroxyurea in chronic myelogenous leukemia (CML). Blood, 84: 382a, 1994. DOI: https://doi.org/10.1182/blood.V84.12.4064.bloodjournal84124064

Allan, N.C.; Richards, S.M.; Shepherd, P.C. A. - UK Medicai Research Council randomised, multicentric trial of interferon-alpha for chronic myeloid leukemia; improved survival irrespective of cytogenetic response. Lancet, 345: 1392, 1995. DOI: https://doi.org/10.1016/S0140-6736(95)92596-1

Butturini, A.; Keating, A. Goldman, J.M.; Gale, R.P. - Autotransplants in CML: Strategies and results. Lancet 1990; 335: 1255. DOI: https://doi.org/10.1016/0140-6736(90)91313-Y

Hughes, T.; Brito-Babapulle, F.; Marcus, R.E. - TransientPh-negativity after autografting with blood-derived stem-cells for patients with chronic myeloid leukemia in chronic phase. Bone Marrow Transplant, 4 (suppl 1): 51, 1989.

Eaves, C.; Udomsakdi, C.; Cashman, J.; Barnett, M.; Eaves, A. - The biology of normal and neoplastic stem-cells in CML. Leuk Kymph, ll(suppl 1): 245, 1993. DOI: https://doi.org/10.3109/10428199309047894

Published

2022-10-03

How to Cite

1.
Garicochea B, Dorlhíac-Llacer PE. Physiopathology and treatment ofchronic myeloid leukemia: new concepts and perspectives. Rev. Bras. Cancerol. [Internet]. 2022 Oct. 3 [cited 2024 May 18];42(2):93-104. Available from: https://rbc.inca.gov.br/index.php/revista/article/view/2894

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ORIGINAL ARTICLE