Monitoring of gene mutations during the treatment of chronic myelitis with bosutinib/bosutinib

During the treatment of patients with chronic myelogenous leukemia (CML), dynamic monitoring of BCR-ABL gene mutations plays a crucial role in drug selection and efficacy evaluation. Bosutinib/Bosutinib, as a second-generation TKI, is mainly used to treat patients who have failed treatment with imatinib, dasatinib or nilotinib. Its efficacy is significantly affected by the type of genetic mutation. Therefore, genetic mutation detection is an important basis for precise medication.

CML is a malignant hematological tumor driven by the BCR-ABL fusion gene, an active tyrosine kinase that has sustained expression in most patients. During TKI treatment, point mutations in the BCR-ABL kinase region may lead to resistance to existing TKI drugs. Among them, T315I is recognized as a “refractory mutation” and is insensitive to most first- and second-generation TKIs. Although bosutinib has certain efficacy against a variety of common mutations, it also has limited efficacy against the T315I mutation. Therefore, the type of genetic mutation directly affects whether bosutinib is selected as an alternative treatment option.

In the early stages of treatment or disease recurrence, it is recommended to use highly sensitive genetic testing technologies such as deep sequencing (NGS) for mutation screening. This not only helps in initial plan formulation, but also provides an early warning mechanism for drug resistance during treatment. If a patient experiences a decrease in molecular response level, an increase in white blood cells, or abnormal blood indicators while using bosutinib, he or she should undergo a timely reexamination to determine whether there are new mutations to avoid delaying the treatment window.

It is worth mentioning that the mutation spectrum may be significantly different among CML patients in the chronic phase, accelerated phase and blast phase.The mutation spectrum may be significantly different, and monitoring frequency and treatment strategies need to be adjusted according to the disease stage. Some experts also recommend combining dual testing of peripheral blood and bone marrow samples under certain circumstances to improve the accuracy of mutation identification.

Reference materials:https://go.drugbank.com/drugs/DB06616