A Retrospective Analysis of <i>BCR-ABL1</i> Kinase Domain Mutations in the Frontline Drug Intolerant or Resistant Chronic Myeloid Leukemia Patients: An Indian Experience from a High-End Referral Laboratory.

Despite the achievements, there has been a major hurdle in the complete success of imatinib, in the form of acquired resistance and intolerance to the drug. Over the past two decades, studies have already identified the mechanisms of drug resistance, that include drug metabolism, bioavailability, leukemic cell evolution, and the most frequently responsible KD point mutations or overexpression of the BCR-ABL1 gene. 9 In one of the earliest comprehensive analyses, 144 Australian patients were evaluated for BCR-ABL1 kinase mutations and a highly significant number of patients (89%) with an underlying mutation developed resistance to imatinib therapy. 25 Ever since, multiple studies have proven the point that close molecular monitoring and prompt mutation analysis is critical for disease management and long-term remission.

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The three patients who harbored F359V mutation ( Table 2 ) showed a trend of shifting to dasatinib to reach CyR or MMR.

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