1.BCR-ABL1 compound mutations combining key kinase domain positions confer clinical resistance to ponatinib in Ph chromosome-positive leukemia.
Zabriskie MS1, Eide CA2, Tantravahi SK3, Vellore NA4, Estrada J1, Nicolini FE5, Khoury HJ6, Larson RA7, Konopleva M8, Cortes JE8, Kantarjian H8, Jabbour EJ8, Kornblau SM8, Lipton JH9, Rea D10, Stenke L11, Barbany G12, Lange T13, Hernández-Boluda JC14, Oss Cancer Cell. 2014 Sep 8;26(3):428-42. doi: 10.1016/j.ccr.2014.07.006. Epub 2014 Aug 14.
Ponatinib is the only currently approved tyrosine kinase inhibitor (TKI) that suppresses all BCR-ABL1 single mutants in Philadelphia chromosome-positive (Ph(+)) leukemia, including the recalcitrant BCR-ABL1(T315I) mutant. However, emergence of compound mutations in a BCR-ABL1 allele may confer ponatinib resistance. We found that clinically reported BCR-ABL1 compound mutants center on 12 key positions and confer varying resistance to imatinib, nilotinib, dasatinib, ponatinib, rebastinib, and bosutinib. T315I-inclusive compound mutants confer high-level resistance to TKIs, including ponatinib. In vitro resistance profiling was predictive of treatment outcomes in Ph(+) leukemia patients. Structural explanations for compound mutation-based resistance were obtained through molecular dynamics simulations. Our findings demonstrate that BCR-ABL1 compound mutants confer different levels of TKI resistance, necessitating rational treatment selection to optimize clinical outcome.