The levels of foxo3a predict the failure of imatinib mesylate therapy among chronic myeloid leukemia patients

BACKGROUND: Forkhead Transcription Factor 3a (FoxO3a) has been proposed to have a high efficacy to predict the failure of imatinib mesylate (IM) therapy among chronic myeloid leukemia (CML) patients. However, the limited evidence had made this marker remained controversy. AIM: We aimed to investigate the correlation between the levels of FoxO3a and the risk of treatment failure of IM therapy in CML patients. METHODS: A prospective cohort study was carried out between February 2019 and February 2020 in Saiful Anwar Hospital, Malang, Indonesia. All CML patients, diagnosed using standard criteria, treated with IM 400 mg/day on our hospital during the study period were included in the study. The levels of FoxO3a were determined using the Enzyme-linked immunosorbent assay using Cusabio Biotech Kit (Cusabio Biotech Co., New York, USA). The treatment response was assessed using the European Leukemia criteria. The correlation and effect estimate between the levels of FoxO3a and treatment response of CML patients was assessed using multiple logistic regressions. RESULTS: Fifty-three CML patients receiving IM in our hospital were included in the study, consisting of 29 patients with good response and 24 patients with non-response. Our study found that CML patients with lower levels of FoxO3a were associated with increased risk to develop treatment failure when treated with IM. Moreover, we also found that higher risk of treatment failure of IM therapy was also found in patients with increased levels of thrombocytes, basophils, and leukocytes, and lower levels of hemoglobin. CONCLUSION: We reveal that FoxO3a is the prominent marker to predict the treatment response of CML patients treated with IM.