Berinstein N L, Reis M D, Ngan B Y, Sawka C A, Jamal H H, Kuzniar B
Department of Medicine, Immunology, University of Toronto, Ontario, Canada.
J Clin Oncol. 1993 Jul;11(7):1344-52. doi: 10.1200/JCO.1993.11.7.1344.
The object of this study was to compare the relative sensitivities of morphologic, immunophenotypic, gene rearrangement, cytogenetic, and polymerase chain reaction (PCR) analyses in the detection of lymphoma cells in the bone marrow and peripheral blood of patients with follicular lymphoma.
Bone marrow and peripheral-blood samples from 28 newly diagnosed patients with follicular lymphoma referred from several different medical centers were assessed. Routine morphologic assessment was performed initially and the remainder of the sample was aliquoted for DNA extraction to be used for gene rearrangement and PCR analyses and for immunophenotypic and cytogenetic analyses where a sufficient amount of sample remained.
Morphologic assessment of the bone marrow was positive for lymphoma cells in 11 of 28 patients. PCR amplification of t(14;18) breakpoint DNA detected lymphoma cells in 17 of 24 patients assessed. Morphologic assessment detected lymphoma cells in three bone marrow samples that were negative by PCR. PCR analysis was the only method able to detect circulating lymphoma cells in peripheral blood at diagnosis and was positive in 15 of 24 samples. The other methods of assessment did not show lymphoma in any samples in which lymphoma was not detected by morphologic or PCR analysis. Lymphoma cells were found in the bone marrow and/or peripheral blood as frequently in early-stage patients as in advanced-stage patients.
PCR amplification of t(14;18) breakpoint DNA together with morphologic assessment had the highest yield of detecting lymphoma cells in the bone marrow and/or peripheral blood of our population of newly diagnosed patients with follicular lymphoma. The clinical significance and prognostic importance of lymphoma cells detected by PCR in the bone marrow and/or peripheral blood of newly diagnosed follicular lymphoma patients awaits long-term follow-up data of these and additional patients.
本研究的目的是比较形态学、免疫表型、基因重排、细胞遗传学和聚合酶链反应（PCR）分析在检测滤泡性淋巴瘤患者骨髓和外周血中淋巴瘤细胞时的相对敏感性。
对来自几个不同医疗中心的28例新诊断的滤泡性淋巴瘤患者的骨髓和外周血样本进行了评估。首先进行常规形态学评估，剩余样本进行等分以提取DNA，用于基因重排和PCR分析，以及在有足够样本剩余时进行免疫表型和细胞遗传学分析。
28例患者中有11例骨髓的形态学评估显示淋巴瘤细胞呈阳性。对24例接受评估的患者进行t(14;18)断点DNA的PCR扩增，检测到17例患者存在淋巴瘤细胞。形态学评估在3例PCR检测为阴性的骨髓样本中检测到淋巴瘤细胞。PCR分析是诊断时唯一能够检测外周血中循环淋巴瘤细胞的方法，24例样本中有15例呈阳性。在形态学或PCR分析未检测到淋巴瘤的任何样本中，其他评估方法均未显示淋巴瘤。早期患者和晚期患者的骨髓和/或外周血中淋巴瘤细胞的检出频率相同。
t(14;18)断点DNA的PCR扩增与形态学评估相结合，在我们新诊断的滤泡性淋巴瘤患者群体的骨髓和/或外周血中检测淋巴瘤细胞的检出率最高。PCR检测到的新诊断滤泡性淋巴瘤患者骨髓和/或外周血中淋巴瘤细胞的临床意义和预后重要性有待这些患者及更多患者的长期随访数据。
