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聚合酶链反应在检测血液系统恶性肿瘤微小残留病中的应用。

Application of the polymerase chain reaction for detection of minimal residual disease of hematologic malignancies.

作者信息

Roth M S, Terry V H

机构信息

Division of Hematology and Oncology, University of Michigan Medical School, Ann Arbor 48105-0650.

出版信息

Henry Ford Hosp Med J. 1991;39(2):112-6.

PMID:1890004
Abstract

Current induction therapies for acute and chronic leukemias and the lymphomas have achieved significant complete remission rates. Despite this initial success, disease recurrence remains a major problem. Relapse from clinically undetectable residual malignant cells is the most likely mechanism of recurrence. Of crucial importance to the clinician is the accurate detection of residual malignant cells prior to clinical relapse. Standard approaches to evaluate for this minimal residual disease (MRD) allow detection only when the malignant clone exceeds 1%. Patients in remission, however, may frequently have residual neoplastic cells that are far below this level. Recently, several investigators have adapted the polymerase chain reaction (PCR) to detect tumor-specific DNA or RNA sequences. This approach is highly sensitive (able to detect 1 malignant cell in 10(6) normal cells). The application of this technique to the study of MRD thus far has been limited to tumors in which specific DNA or RNA sequence data are available. This review describes the application of PCR to the detection of MRD in patients with chronic myelogenous leukemia, acute lymphoblastic leukemia, and follicular small cleaved cell lymphoma. Because the number of clinical studies and length of follow-up is limited, detection of MRD by PCR is at present largely a research tool and the biological significance of MRD as determined by PCR must await further studies.

摘要

目前用于急性和慢性白血病以及淋巴瘤的诱导疗法已取得了显著的完全缓解率。尽管取得了这一初步成功,但疾病复发仍然是一个主要问题。临床无法检测到的残留恶性细胞复发是最可能的复发机制。对临床医生至关重要的是在临床复发之前准确检测残留恶性细胞。评估这种微小残留病(MRD)的标准方法只有在恶性克隆超过1%时才能检测到。然而,处于缓解期的患者可能经常有远低于这一水平的残留肿瘤细胞。最近,一些研究人员采用聚合酶链反应(PCR)来检测肿瘤特异性DNA或RNA序列。这种方法高度灵敏(能够在10⁶个正常细胞中检测到1个恶性细胞)。迄今为止,这项技术在MRD研究中的应用仅限于那些有特定DNA或RNA序列数据的肿瘤。这篇综述描述了PCR在慢性粒细胞白血病、急性淋巴细胞白血病和滤泡性小裂细胞淋巴瘤患者MRD检测中的应用。由于临床研究的数量和随访时间有限,目前通过PCR检测MRD在很大程度上仍是一种研究工具,通过PCR确定的MRD的生物学意义有待进一步研究。

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