[B细胞淋巴瘤患者骨髓中免疫球蛋白重链克隆重排检测的临床意义]

[Clinical significance in detection of immunoglobulin heavy chain clonal rearrangement in bone marrow of patients with B cell lymphoma].

作者信息

Chen Zhi-yu, Zhou Xiao-yan, Zhang Tai-ming, Hong Xiao-nan, Yin Ji-liang, Hu Xi-chun, Shi Da-ren

机构信息

Department of Medical Oncology, Cancer Hospital, Fudan University, Shanghai 200032, China.

出版信息

Zhonghua Zhong Liu Za Zhi. 2009 Mar;31(3):183-8.

PMID:19615255

Abstract

OBJECTIVE

To explore the feasibility of semi-nested PCR technique for detection of immunoglobulin heavy chain (IgH) clonal rearrangement in bone marrow of B-cell lymphoma patient and to further evaluate its clinicopathological value.

METHODS

Gene clonal rearrangement of IgH was detected by semi-nested PCR using primers of FR2 & FR3A in 105 bone marrow samples of patients with B-cell lymphoma. The PCR detection results were compared with the cytomorphology of bone marrow aspiration biopsy. The correlation between PCR detection results and clinicopathological factors were evaluated.

RESULTS

Among 105 cases of B-cell lymphoma, bone marrow involvement was detected by PCR technique in 48 cases (45.7%), while only 22 cases (21.0%) were detected by bone marrow cytological analysis. There was a significant difference between two methods (P < 0.05), and the concordance rate was 71.4%. The incidence of bone marrow involvement at the time of initial diagnosis detected by PCR technique was 30.8% for diffuse large B cell lymphoma (DLBCL), 25.0% for follicular lymphoma (FL), and 100.0% for small lymphocytic lymphoma (SLL), respectively. Bone marrow involvement detected by PCR detection correlated with Ann Arbor stage. Rate of clonal IgH gene rearrangement by PCR in early B-cell lymphoma was lower than that in advanced stage B-cell lymphoma patients (P = 0.02). There was no statistically significant difference in efficacy between patients with positive and negative results detected by PCR (P > 0.05). But difference in complete response (CR) rate (23.3% and 46.3%) had significant difference (P = 0.019).

CONCLUSION

Semi-nested PCR analysis may be an effective method for detection of abnormalities in bone marrow in patients with B-cell lymphoma and is superior to cytomorphology. The positive rate in patients with advanced Ann Arbor stage is higher than that in patients with early Ann Arbor stage, and patients with PCR negative result have more chances to achieved CR after treatment.

摘要

目的

探讨半巢式聚合酶链反应（PCR）技术检测B细胞淋巴瘤患者骨髓中免疫球蛋白重链（IgH）基因克隆重排的可行性，并进一步评估其临床病理价值。

方法

采用FR2和FR3A引物，通过半巢式PCR检测105例B细胞淋巴瘤患者骨髓标本的IgH基因克隆重排。将PCR检测结果与骨髓穿刺活检的细胞形态学结果进行比较。评估PCR检测结果与临床病理因素之间的相关性。

结果

105例B细胞淋巴瘤患者中，PCR技术检测到骨髓受累48例（45.7%），而骨髓细胞学分析仅检测到22例（21.0%）。两种方法差异有统计学意义（P<0.05），符合率为71.4%。PCR技术检测初诊时弥漫性大B细胞淋巴瘤（DLBCL）骨髓受累发生率为30.8%，滤泡性淋巴瘤（FL）为25.0%，小淋巴细胞淋巴瘤（SLL）为100.0%。PCR检测到的骨髓受累与Ann Arbor分期相关。早期B细胞淋巴瘤患者PCR检测的克隆性IgH基因重排率低于晚期B细胞淋巴瘤患者（P=0.02）。PCR检测结果阳性和阴性患者的疗效差异无统计学意义（P>0.05）。但完全缓解（CR）率差异有统计学意义（23.3%和46.3%，P=0.019）。