Department of Internal Medicine, University of Genoa, Viale Benedetto XV 6, Genoa, Italy.
Int J Lab Hematol. 2010 Aug 1;32(4):387-91. doi: 10.1111/j.1751-553X.2009.01198.x. Epub 2009 Nov 30.
Molecular monitoring of the BCR-ABL1 transcript in chronic myelogenous leukemia (CML) using quantitative real-time PCR (RQ-PCR) can be performed using either bone marrow (BM) or peripheral blood (PB). However, a recent report by Stock et al. [International Journal of Oncology 28 (2006) 1099] questioned the reliability of PB samples for BCR-ABL1 detection as performed by RQ-PCR. We report a study on 114 CML patients who received allogeneic stem cell transplantation (ASCT), and who were monitored by RQ-PCR using paired samples of BM and PB: the total number of determinations was 428, with a median follow-up after transplant of 8 years. BCR-ABL1 transcript was undetectable or <0.1%, in 106 (49.57%) and 62 (29%) paired determinations, respectively. BCR-ABL1 was >0.1% in 36 (16.8%) paired determinations and was discordant in 10 (4.7%). Agreement between PB and BM results was quantified by the kappa test (k = 0.85; 95% CI 0.76-0.94). This study shows that BCR-ABL1 RQ-PCR monitoring of CML patients after ASCT with PB is concordant with BM in 95.3% of cases, and thus may be used to monitor the disease. This may be relevant when discussing both quality of life issues and the need for post-transplant monitoring with the patient.
采用实时定量聚合酶链反应（RQ-PCR）对慢性髓性白血病（CML）中的 BCR-ABL1 转录本进行分子监测，可以使用骨髓（BM）或外周血（PB）进行。然而，Stock 等人最近的一份报告[International Journal of Oncology 28 (2006) 1099]对 RQ-PCR 检测 PB 样本中 BCR-ABL1 的可靠性提出了质疑。我们报告了一项对 114 例接受异基因干细胞移植（ASCT）的 CML 患者进行的研究，这些患者通过 RQ-PCR 采用 BM 和 PB 的配对样本进行监测：总共进行了 428 次检测，移植后中位随访时间为 8 年。BCR-ABL1 转录本在 106（49.57%）和 62（29%）对配对检测中均不可检测或<0.1%。36（16.8%）对配对检测中 BCR-ABL1>0.1%，10（4.7%）对配对检测中存在不一致。通过 Kappa 检验（k=0.85；95%置信区间 0.76-0.94）量化了 PB 和 BM 结果之间的一致性。这项研究表明，在 ASCT 后对 CML 患者进行 BCR-ABL1 RQ-PCR 监测时，PB 与 BM 的一致性为 95.3%，因此可以用于监测疾病。这在与患者讨论生活质量问题和移植后监测的必要性时可能具有重要意义。
