The bone marrow microenvironment as a sanctuary for minimal residual disease in CML.

Abstract:

:Bcr-abl kinase inhibitors have provided proof of principal that targeted therapy holds great promise for the treatment of cancer. However, despite the success of these agents in treating chronic myelogenous leukemia (CML), the majority of patients continue to present with minimal residual disease contained within the bone marrow microenvironment. These clinical observations suggest that the bone marrow microenvironment may provide survival signals that contribute to the failure to eliminate minimal residual disease. The bone marrow microenvironment is comprised of multiple sub-domains which vary in cellular composition and gradients of soluble factors and matrix composition. Experimental evidence indicate that exposure of tumor cells to either bone marrow derived soluble factors or the extracellular matrix can confer a multi-drug resistance phenotype. Together, these data indicate that targeting such pathways may be a viable approach for increasing the efficacy of chemotherapy. Moreover, we propose that personalized medicine must go beyond understanding predictive models inherent to tumors but rather build predictive models that consider diversity in response due to interactions with the tumor microenvironment. Although review will focus on CML, understanding the contribution of the bone marrow microenvironment could contribute to rationale combination therapy in other types of leukemia, multiple myeloma and solid tumors which metastasize to the bone.

journal_name

Biochem Pharmacol

journal_title

Biochemical pharmacology

authors

Nair RR,Tolentino J,Hazlehurst LA

doi

10.1016/j.bcp.2010.04.003

subject

Has Abstract

pub_date

2010-09-01 00:00:00

pages

602-12

issue

5

eissn

0006-2952

issn

1873-2968

pii

S0006-2952(10)00248-0

journal_volume

80

pub_type

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