Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan.
Department of Next Generation Hematology Laboratory Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.
PLoS One. 2019 Mar 5;14(3):e0207170. doi: 10.1371/journal.pone.0207170. eCollection 2019.
Tyrosine kinase inhibitors (TKIs) targeting the BCR-ABL1 fusion protein, encoded by the Philadelphia chromosome, have drastically improved the outcomes for patients with chronic myeloid leukemia (CML). Although several real-time quantitative polymerase chain reaction (RQ-PCR) kits for the detection of BCR-ABL1 transcripts are commercially available, their accuracy and efficiency in laboratory practice require reevaluation. We have developed a new in-house RQ-PCR method to detect minimal residual disease (MRD) in CML cases. MRD was analyzed in 102 patients with CML from the DOMEST study, a clinical trial to study the rationale for imatinib mesylate discontinuation in Japan. The BCR-ABL1/ABL1 ratio was evaluated using the international standard (IS) ratio, where IS < 0.1% was defined as a major molecular response. At enrollment, BCR-ABL1 transcripts were undetectable in all samples using a widely-applied RQ-PCR method performed in the commercial laboratory, BML (BML Inc., Tokyo, Japan); however, the in-house method detected the BCR-ABL1 transcripts in five samples (5%) (mean IS ratio: 0.0062 ± 0.0010%). After discontinuation of imatinib, BCR-ABL1 transcripts were detected using the in-house RQ-PCR in 21 patients (21%) that were not positive using the BML method. Nineteen samples were also tested using a commercially available RQ-PCR assay kit with a detection limit of IS ratio, 0.0032 (ODK-1201, Otsuka Pharmaceutical Co., Tokyo, Japan). This method detected low levels of BCR-ABL1 transcripts in 14 samples (74%), but scored negative for five samples (26%) that were positive using the in-house method. From the perspective of the in-house RQ-PCR method, number of patients confirmed loss of MMR was 4. These data suggest that our new in-house RQ-PCR method is effective for monitoring MRD in CML.
酪氨酸激酶抑制剂 (TKI) 靶向费城染色体编码的 BCR-ABL1 融合蛋白,极大地改善了慢性髓细胞白血病 (CML) 患者的预后。虽然有几种用于检测 BCR-ABL1 转录本的实时定量聚合酶链反应 (RQ-PCR) 试剂盒可商购,但它们在实验室实践中的准确性和效率需要重新评估。我们开发了一种新的内部 RQ-PCR 方法来检测 CML 病例中的微小残留病 (MRD)。在日本的一项研究伊马替尼甲磺酸停药合理性的临床试验 DOMEST 研究中,对 102 例 CML 患者进行了 MRD 分析。使用国际标准 (IS) 比值评估 BCR-ABL1/ABL1 比值,其中 IS < 0.1% 定义为主要分子反应。在入组时,使用商业实验室中广泛应用的 RQ-PCR 方法 BML(BML Inc.,东京,日本)检测所有样本中均未检测到 BCR-ABL1 转录本;然而,内部方法在 5 个样本中检测到 BCR-ABL1 转录本(5%)(平均 IS 比值:0.0062 ± 0.0010%)。在停止使用伊马替尼后,使用内部 RQ-PCR 在 21 例(21%)患者中检测到 BCR-ABL1 转录本,而使用 BML 方法则未检测到阳性。还使用检测限为 IS 比值 0.0032 的商业 RQ-PCR 检测试剂盒(ODK-1201,大冢制药株式会社,东京,日本)对 19 个样本进行了测试。该方法在 14 个样本(74%)中检测到低水平的 BCR-ABL1 转录本,但对 5 个样本(26%)的结果为阴性,而内部方法为阳性。从内部 RQ-PCR 方法的角度来看,有 4 名患者被确认为失去了 MMR。这些数据表明,我们的新内部 RQ-PCR 方法可有效监测 CML 中的 MRD。