Evidence of massive leukemic progenitor expansion in blood during molecular recurrence after TKI discontinuation in chronic myeloid leukemia (CML)

Chronic myeloid leukemia (CML) represents one of the major success stories of targeted therapies of the 21st century with the use of tyrosine kinase inhibitors (TKIs). Following discontinuation of TKIs in deep molecular remission context, at least half of the patients experience molecular relapse. Cellular events occurring during this phase are not yet established. In this work, we show a massive amplification of clonogenic progenitors or CFCs (colony-forming cells) in the peripheral blood of patients in molecular recurrence after a TKI discontinuation. We demonstrate, by qRT-PCR analysis on individual and pooled CFCs, that leukemic clonogenic progenitor expansion in the peripheral blood represents the first cellular event before any evidence of cytological change. These findings also suggest that the amplification of the leukemic clone during the first stages of CML takes place not only in the bone marrow but also in the peripheral blood.