Mitterbauer-Hohendanner G, Mannhalter C, Winkler K, Mitterbauer M, Skrabs C, Chott A, Simonitsch-Klupp I, Gleiss A, Lechner K, Jaeger U
Clinical Institute of Medical and Chemical Laboratory Diagnostics, Division of Molecular Diagnostics, University of Vienna, Medical School, Währinger Gürtel, Vienna, Austria.
Leukemia. 2004 Jun;18(6):1102-7. doi: 10.1038/sj.leu.2403376.
The prognostic value of the detection of peripheral blood (PB) and/or bone marrow (BM) involvement by polymerase chain reaction (PCR) amplification of rearranged immunoglobulin heavy chain (IgH) and immunoglobulin kappa light chain (Igkappa) genes was evaluated in 155 patients with diffuse large B-cell lymphomas (DLBCL). Immunoglobulin gene rearrangements (IgR) were detected in 35/155 (23%) patients. The presence of IgR in PB/BM was related to clinical stage (CS I-III vs CS IV; P<0.001), histopathological detection of BM involvement (P<0.001), and the International Prognostic Index (P<0.001). IgR-positive cases had a significantly lower complete remission (CR) rate (18/35, 51%) than IgR-negative patients (85/120, 71%; P=0.042), and a significantly poorer overall survival (OAS) at 5 years (25 vs 66%; P<0.001). There was a significant difference in the estimated OAS at 5 years between patients with negative BM histology and negative PCR results (66%), patients with negative BM histology but positive IgR (37%), and patients with positive BM histology (12%). Our results indicate that molecular methods improve the accuracy of staging in patients with DLBCL and define a group of patients with normal bone marrow histology who have a significantly poorer OAS due to molecular detection of PB/BM involvement.
通过聚合酶链反应（PCR）扩增重排的免疫球蛋白重链（IgH）和免疫球蛋白κ轻链（Igκ）基因来检测外周血（PB）和/或骨髓（BM）受累情况，对155例弥漫性大B细胞淋巴瘤（DLBCL）患者的预后价值进行了评估。在155例患者中有35例（23%）检测到免疫球蛋白基因重排（IgR）。PB/BM中IgR的存在与临床分期（CS I - III期与CS IV期；P<0.001）、BM受累的组织病理学检测结果（P<0.001）以及国际预后指数（P<0.001）相关。IgR阳性病例的完全缓解（CR）率（18/35，51%）显著低于IgR阴性患者（85/120，71%；P = 0.042），且5年总生存率（OAS）显著更差（25%对66%；P<0.001）。BM组织学阴性且PCR结果阴性的患者、BM组织学阴性但IgR阳性的患者以及BM组织学阳性的患者在5年估计OAS方面存在显著差异（分别为66%、37%和12%）。我们的结果表明，分子方法提高了DLBCL患者分期的准确性，并确定了一组骨髓组织学正常但由于PB/BM受累的分子检测而OAS显著更差的患者。
