Emergence role of nucleated red blood cells in molecular response evaluation for chronic myeloid leukemia

Abstract

Thang Thanh Phan1,2, Ha The Vy3, Toan Trong Ho2, Vinh Thanh Tran2, Tung Thanh Tran3, Suong Phuoc Pho1, Tuyen Thi Bich Pham2, Thao Thi Le2, Son Truong Nguyen4,5 1Biomolecular & Genetic Unit, Clinical Cancer Center, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam; 2Laboratory D Unit, Clinical Cancer Center, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam; 3Department of Hematology, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam; 4Department of General Director, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam; 5Department of the Vice Minister, Ministry of Health, Hanoi City 100000, VietnamCorrespondence: Son Truong NguyenDepartment of the Vice Minister, Ministry of Health, 138A Giang Vo Street, Ba Dinh District, Hanoi City 100000, VietnamTel [phone]Fax [phone]Email [email protected]: To investigate and evaluate the role of nucleated red blood cells (NRBCs) and other markers in predicting remission failure in chronic myeloid leukemia (CML) patients treated with imatinib.Methods: Seventy-one CML patients with BCR-ABL(+) in bone marrow cells were selected for this study. Molecular response evaluations were done every three months according to the recommendations of European LeukemiaNet (ELN). Patients were defined as remission failure if BCR-ABL transcripts >10% after 6 months (T6), >1% after 12 months (T12), and >0.1% after 18 (T18) months of treatment. The logistic regression was used to determine the optimal cut-off point of each marker and test the association of marker level with remission failure.Results: The median NRBC, white blood cells, blast cells, basophils, and platelets were declined parallel with the decreases of BCR-ABL transcripts in bone marrow cells after 6 months of treatment (P<0.001). In addition, NRBC was almost not found in the blood of patients who archived good response at T6, T12, and T18 time-points. Interestingly, patients with a high level of NRBC (cut-off: 0.003×109/L) have higher BCR-ABL transcripts compared to others. The elevated NRBC at T6 (OR=6.49, P=0.042), T12 (OR=6.73, P=0.007), and T18 (OR=5.96, P=0.009) time-points was identified as an independent factor for the remission failure.Conclusion: The results of this study showed that a high number of NRBC in peripheral blood of CML patients is associated with higher BCR-ABL transcripts in bone marrow cells. The elevated NRBC might serve as an independent marker for molecular remission failure in CML.Keywords: NRBC, BCR-ABL, CML

Keywords

• NRBC
• BCR-ABL
• CML