Dynamics of mutations in patients with essential thrombocythemia treated with imetelstat.

Oppliger Leibundgut, Elisabeth; Haubitz, Monika; Burington, Bart; Ottmann, Oliver G; Spitzer, Gary; Odenike, Olatoyosi; McDevitt, Michael A; Röth, Alexander; Snyder, David S; Baerlocher, Gabriela M. (2020). Dynamics of mutations in patients with essential thrombocythemia treated with imetelstat. (In Press). Haematologica - the hematology journal Ferrata-Storti Foundation 10.3324/haematol.2020.252817

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In a phase-2 study, the telomerase inhibitor imetelstat induced rapid hematologic responses in all patients with essential thrombocythemia who were refractory or intolerant to prior therapies. Significant molecular responses were achieved within 3-6 months in 81% of patients with phenotypic driver mutations in JAK2, CALR and MPL. Here, we investigated the dynamics of additional somatic mutations in response to imetelstat. At study entry, 50% of patients carried 1-5 additional mutations in the genes ASXL1, CBL, DNMT3A, EZH2, IDH1, SF3B1, TET2, TP53 and U2AF1. Three patients with baseline mutations also had late-emerging mutations in TP53, IDH1 and TET2. Most clones with additional mutations were responsive to imetelstat and decreased with the driver mutation, including the poor prognostic ASXL1, EZH2 and U2AF1 mutations while SF3B1 and TP53 mutations were associated with poorer molecular response. Overall, phenotypic driver mutation response was significantly deeper in patients without additional mutations (P = 0.04) and correlated with longer duration of response. In conclusion, this detailed molecular analysis of highly pretreated and partly resistant patients with essential thrombocythemia reveals a high individual patient complexity. Moreover, imetelstat demonstrates potential to inhibit efficiently co-incident mutations occurring in neoplastic clones in patients with essential thrombocythemia. (ClinicalTrials.gov number, NCT01243073 N Engl J Med 2015; 373:920-928, DOI: 10.1056/NEJMoa1503479.).

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Haematology and Central Haematological Laboratory
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > Unit Childrens Hospital > Forschungsgruppe Hämatologie (Erwachsene)

UniBE Contributor:

Oppliger Leibundgut, Elisabeth; Haubitz, Monika and Baerlocher, Gabriela M.

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0390-6078

Publisher:

Ferrata-Storti Foundation

Language:

English

Submitter:

Pierrette Durand Lüthi

Date Deposited:

04 Aug 2020 14:04

Last Modified:

04 Aug 2020 14:04

Publisher DOI:

10.3324/haematol.2020.252817

PubMed ID:

32732354

Uncontrolled Keywords:

Essential Thrombocythemia Imetelstat Molecular Response Mutation

BORIS DOI:

10.7892/boris.145560

URI:

https://boris.unibe.ch/id/eprint/145560

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