Martinelli G, Sessarego M, Gasparini P, Ambrosetti A, Frassoni F, Chiamenti A M, Pignatti P F
Institute of Biological Sciences, University of Verona, Italy.
Bone Marrow Transplant. 1991;7 Suppl 2:21.
The Polymerase Chain Reaction (PCR) was used to evaluate minimal residual disease in 21 Ph+ CML patients at various intervals after allogeneic bone-marrow transplantation (ABMT) by amplification of bcr-abl cDNA. All patients were cytogenetically Ph- at the moment of molecular analysis. Of these 76% were PCR negative, 24% positive for bcr-abl transcripts. 100% of the Cyclosporine A/Methotrexate treated patients (7/7) were negative. Severe chronic GvHD was twice as frequent in PCR positive patients (60%) than in negative ones (31%). The only patient who relapsed during follow up was PCR positive. The two longest survivors were PCR negative. These data are still insufficient for assessing the predictive value of PCR analysis in CML. Patients. 25 patients with Ph+ CML at diagnosis were enrolled in this study. Two died soon after BMT because of infection for failure of engraftment/early relapse, two were Ph chromosome positive and PCR+, and were therefore dismissed from this study. All remaining 21 patients were cytogenetically Ph- at the time of molecular analysis and underwent ABMT from matched donors. All patients were conditioned with cyclophosphamide and TBI: 330 cGy the three days prior to transplantation (990 cGy total, treatment B), or 200 cGy two times daily for three days (1200 cGy total, treatment A). In 3 cases the marrow was treated for GvHD prophilaxis with Campath alone or Campath plus BT 5/9 monoclonal antibodies (1). All patients were treated with Cyclosporin A (CS) 5 mg/kg i.v. from the day prior to transplantation until 25-30 days after; 9 of these were treated with CS plus Methotrexate (MTX).
采用聚合酶链反应（PCR）通过扩增bcr-abl cDNA，在21例异基因骨髓移植（ABMT）后的不同时间点评估慢性粒细胞白血病（CML）患者微小残留病。在进行分子分析时，所有患者细胞遗传学检查均为Ph阴性。其中76%的患者PCR检测为阴性，24%的患者bcr-abl转录本呈阳性。接受环孢素A/甲氨蝶呤治疗的患者（7/7）100%为阴性。PCR阳性患者中重度慢性移植物抗宿主病（GvHD）的发生率（60%）是阴性患者（31%）的两倍。随访期间唯一复发的患者PCR检测为阳性。存活时间最长的两名患者PCR检测为阴性。这些数据仍不足以评估PCR分析对CML的预测价值。患者。25例诊断为Ph+CML的患者纳入本研究。两名患者在骨髓移植后不久因感染导致植入失败/早期复发死亡，两名患者Ph染色体阳性且PCR阳性，因此被排除在本研究之外。其余21例患者在进行分子分析时细胞遗传学检查均为Ph阴性，并接受了来自匹配供体的ABMT。所有患者均接受环磷酰胺和全身照射（TBI）预处理：移植前三天给予330 cGy（总量990 cGy，方案B），或连续三天每天两次给予200 cGy（总量1200 cGy，方案A）。3例患者的骨髓单独使用Campath或联合BT 5/9单克隆抗体进行移植物抗宿主病预防治疗（1）。所有患者自移植前一天起静脉注射环孢素A（Cs）5 mg/kg，直至移植后25 - 30天；其中9例患者接受Cs加甲氨蝶呤（MTX）治疗。
