Gribben J G, Neuberg D, Barber M, Moore J, Pesek K W, Freedman A S, Nadler L M
Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA 02215.
Blood. 1994 Jun 15;83(12):3800-7.
Polymerase chain reaction (PCR) amplification of the t(14;18) has been shown to be a highly sensitive method to detect minimal residual disease in patients with non-Hodgkin's lymphoma (NHL) whose tumors bear this translocation. The ideal tissue source to detect residual lymphoma would be from a previously involved lymph node. However, lymphoid tissue is rarely available once patients achieve complete remission. Although PCR amplification has been used to detect residual lymphoma cells in both bone marrow (BM) and peripheral blood (PB) of patients in complete remission, it is presently unknown whether BM and PB are equivalent tissue sources to detect residual disease. In the present study, we compared the clinical utility of the detection of residual lymphoma in both the BM and the PB of patients with advanced-stage non-Hodgkin's lymphoma before, at the time of, and after high-dose therapy and autologous BM transplantation (ABMT). The detection of residual lymphoma in either the BM or PB was associated with decreased disease-free survival. However, in the present study, 44% of patients who relapsed had no evidence of circulating lymphoma cells in their PB. At the time of BM harvest, PCR-detectable residual lymphoma cells were detected in 211 of 212 patients; although, in a subset of these patients analyzed, lymphoma cells were detected in the peripheral blood of only 49% of patients. When residual lymphoma cells within the autologous BM are infused into the patient these cells are rapidly detectable circulating in the PB in the patient. These cells continue to circulate during the immediate posttransplant period and be detectable in the PB in the majority of patients who are infused with marrow containing residual lymphoma. We conclude that BM is a more informative tissue source than PB in detecting minimal residual disease at the time of and after ABMT, and that contamination of PB early after ABMT appears to be the consequence of reinfusion of lymphoma cells within autologous marrow.
聚合酶链反应（PCR）扩增t(14;18)已被证明是检测患有t(14;18)易位非霍奇金淋巴瘤（NHL）患者微小残留病的高灵敏度方法。检测残留淋巴瘤的理想组织来源是先前受累的淋巴结。然而，一旦患者达到完全缓解，淋巴组织就很少能获取到。尽管PCR扩增已用于检测完全缓解患者骨髓（BM）和外周血（PB）中的残留淋巴瘤细胞，但目前尚不清楚BM和PB是否是检测残留病的等效组织来源。在本研究中，我们比较了晚期非霍奇金淋巴瘤患者在高剂量治疗及自体骨髓移植（ABMT）前、期间和之后，检测其BM和PB中残留淋巴瘤的临床效用。在BM或PB中检测到残留淋巴瘤与无病生存期缩短相关。然而，在本研究中，44%复发患者的PB中没有循环淋巴瘤细胞的证据。在采集骨髓时，212例患者中有211例检测到PCR可检测的残留淋巴瘤细胞；尽管在这些分析的患者亚组中，仅49%患者的外周血中检测到淋巴瘤细胞。当将自体骨髓中的残留淋巴瘤细胞注入患者体内时，这些细胞可在患者的PB中迅速检测到循环。这些细胞在移植后即刻期间持续循环，并且在大多数输注含有残留淋巴瘤骨髓的患者的PB中可检测到。我们得出结论，在ABMT期间及之后检测微小残留病时，BM是比PB更具信息价值的组织来源，并且ABMT后早期PB的污染似乎是自体骨髓中淋巴瘤细胞再输注的结果。
