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CML with T315I gatekeeper mutation in the BCR-ABL1 kinase domain — resistant to all 1st/2...

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IDRF-CML-T315I-MUTATION
TypeSignal d’alerte
Étatreviewed 2026-04-25 | pending_clinical_signoff
MaladiesDIS-CML
SourcesSRC-ELN-CML-2020 SRC-NCCN-MPN-2025

Origine du drapeau rouge

DéfinitionCML with T315I gatekeeper mutation in the BCR-ABL1 kinase domain — resistant to all 1st/2nd-gen TKIs; requires ponatinib or asciminib (STAMP)
Direction cliniqueintensifier
Catégoriehigh-risk-biology
Algorithme de décalageALGO-CML-1L

Logique de déclenchement

{
  "any_of": [
    {
      "finding": "bcr_abl_t315i",
      "value": true
    },
    {
      "finding": "kinase_domain_mutation",
      "value": "T315I"
    }
  ],
  "type": "biomarker"
}

Notes

T315I emergence on imatinib / 2nd-gen TKI mandates switch to ponatinib (full-dose 45 mg → response-adjusted to 15 mg per OPTIC) or asciminib STAMP (response rates ~50% in T315I-positive). Both NOT registered in Ukraine — major access barrier. AlloHCT remains alternative for fit patients without ponatinib/asciminib access. Mandatory kinase-domain resistance mutation screening at TKI failure or suboptimal response per ELN 2020 milestones. STUB — requires clinical co-lead signoff.

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