rev bras hematol hemoter. 2017;39(3):197–198
w w w . r b h h . o r g
Revista
Brasileira
de
Hematologia
e
Hemoterapia
Brazilian
Journal
of
Hematology
and
Hemotherapy
Scientific
Comment
BCR-ABL1
level
monitoring
in
chronic
myeloid
leukemia
by
real
time
polymerase
chain
reaction
in
Brazil
–
not
so
real
夽
Katia
Borgia
Barbosa
Pagnano
∗UniversidadeEstadualdeCampinas(Unicamp),Campinas,SP,Brazil
Chronicmyeloidleukemia(CML)hasbeensuccessfully man-agedsincetyrosinekinaseinhibitors(TKI)becameavailable. Quantitativemonitoringofthepercentageofthefusion tran-scriptBCR-ABL1(breakpointclusterregion–c-Abelsonmurine leukemiaoncogene1,non-receptortyrosinekinase)byreverse transcription-quantitativereal-timepolymerase chain reac-tion(RQ-PCR)iscurrentlythestandardofcareafterstarting TKIs,asrecommendedbytheEuropeanLeukemia Netand Associac¸ãoBrasileiradeHematologia,HemoterapiaeTerapia Cel-lular(ABHH)guidelines.1,2
Theprognostic value of early molecular responses was demonstratedinseveraltrials, infirst andsecond-line sce-narios.PatientswithBCR-ABL levels>10% atthreemonths havelowerratesofoverallandprogression-freesurvivaland increasedriskofdiseaseprogression.3–6
TheEuropeanLeukemiaNetrecommendsRQ-PCRto deter-minetheBCR-ABL1transcriptlevelontheinternationalscale everythreemonthsuntilamajormolecularresponse(MMR –BCR-ABL ≤0.1%,or MR3.0)hasbeen achieved,then every
threetosixmonths.2 Patientswithfailureofcurrent
treat-mentshouldswitchtherapytoavoiddiseaseprogressionto advancedphases.
DOIoforiginalarticle:http://dx.doi.org/10.1016/j.bjhh.2017.04.007. 夽
SeepaperbyVieira-Mionetal.onpages210–5.
∗ Correspondingauthorat:CentrodeHematologiaeHemoterapia,UniversidadeEstadualdeCampinas(Unicamp),RuaCarlosChagas480,
CidadeUniversitáriaZeferinoVaz,13092-801Campinas,SP,Brazil.Tel.:+551935218740. E-mailaddress:kborgia@unicamp.br
More recently, the successful results of international discontinuationtrialsdemonstratedthatitispossibleto dis-continueTKItreatmentinapproximately40–50%ofpatients thatachievestabledeepmolecularresponses.7,8Thiskindof
approachisnotfeasiblewithoutclosemonitoringofBCR-ABL levelsbyRQ-PCR.
ThestandardizationofRQ-PCRischallengingandinvolves sample exchanges with reference laboratories, equipment, trainedstaff,reagentsandcalibrators,allofwhichhavean impactonthecostofthetest.9,10InBrazil,therearenotmany
standardizedlaboratoriesabletoperformBCR-ABL monitor-ing andtoreportthe resultsaccording tothe international scale.
In the current issue of the Revista Brasileira de Hema-tologia e Hemoterapia, in the article “Molecular response to imatinibmesylateofBrazilianpatientswithchronicmyeloid leukemia”,Mionetal.describetheresultsofRQ-PCR mon-itoring in a large group of patients and demonstrate the importanceofthistestinmanagingCMLpatients.11
Unfortunately,RQ-PCRisnotwidelyavailableforallCML patients in Brazil, where most are treated by the public nationalhealth system(SUS).ThecostofTKIs ishigh and
http://dx.doi.org/10.1016/j.bjhh.2017.05.005
198
revbrashematolhemoter.2017;39(3):197–198paidforbythe government. However,RQ-PCR isnot reim-bursed, and,as aconsequence,who will paythe cost? An additionalproblemisthestandardizationoflaboratoriesand thedistancefrommanycenterstoareferencelaboratory.
Adequate BCR-ABL monitoring may save costs in CML treatmentbyallowingchanges intreatmentbeforedisease progression and allowing for some patients to safely stop treatmentatthecorrectpointintime.Butsofar,itisnota realityformostCMLpatientsinBrazil.
Conflicts
of
interest
Theauthordeclaresnoconflictsofinterest
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