Small gene changes in some leukemia patients may explain varying responses to chemotherapy

A new study provides evidence that may explain why some patients with chronic lymphocytic leukemia (CLL) are resistant to chemotherapy and have a shorter survival time and may identify a potential new target for treating the disease. Patients who had an insertion in the promoter region of a gene that regulates apoptosis, or programmed cell death, were more likely to have a poor response to chemotherapy and to have a rapid progression of the disease, according to the study, which is published in the May 5 issue of the Journal of the National Cancer Institute.

CLL is the most common form of leukemia in the United States: about 12,000 new cases are diagnosed each year. Unlike most cancers that occur because cells divide uncontrollably, CLL is caused primarily by defective apoptosis. Cells live an unnaturally long time and fail to die when they should. Patients diagnosed with CLL can live for months or years and can have varying responses to chemotherapy, although researchers do not know why this is the case or how to predict a patient's prognosis.

Increased levels of a protein called Mcl-1 have previously been associated with a lack of response to chemotherapy in CLL patients. To explore the mechanisms that might be responsible for these increased levels, Anurag Saxena, M.D., of the University of Saskatchewan and the Royal University Hospital in Saskatoon, Saskatchewan, Canada, and colleagues sequenced the MCL-1 gene from 58 CLL patients and 18 control subjects. They also measured expression levels of MCL-1 mRNA and Mcl-1 protein.

The researchers found insertions of 6 or 18 nucleotides in the promoter region of the MCL-1 gene in 17 of 58 CLL patients and in none of the controls. The insertions were all found in the same site in the promoter, in a region that contains binding sites for several transcription factors. Transcription factors are proteins that initiate or regulate the transcription of DNA into mRNA. Patients with the insertion

Contact: Sarah L. Zielinski
Journal of the National Cancer Institute

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