Honda H, Miyagawa K, Endo M, Takaku F, Yazaki Y, Hirai H
Third Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Japan.
Int J Hematol. 1993 Jun;57(3):221-7.
We diagnosed a patient with chronic myelogenous leukemia (CML) in chronic phase (CP) on the basis of clinical findings, Ph1 chromosome detected by cytogenetic analysis, and bcr-abl fusion mRNA detected by reverse transcriptase-dependent polymerase chain reaction (RT-PCR). One month after diagnosis, the patient developed extramedullary blast crisis in the lymph nodes, and then medullary blast crisis in the bone marrow, in which different surface markers were shown. Combination chemotherapy with BH-AC, VP16, and mitoxantrone was administered; this resulted in rapid disappearance of the lymphadenopathy, restoration of normal hematopoiesis, and no Ph1 chromosome being detected by cytogenetic analysis. RT-PCR performed to detect the residual Ph1 clone revealed that although the Ph1 clone was preferentially suppressed, it was still residual. The intensive chemotherapy regimen preferentially suppressed the Ph1-positive clone and led to both clinical and cytogenetic remission in this patient with BC of CML; we suggest that RT-PCR is a sensitive and useful method for detecting minimal residual disease during the clinical course of this disease.
我们根据临床表现、细胞遗传学分析检测到的Ph1染色体以及逆转录酶依赖性聚合酶链反应（RT-PCR）检测到的bcr-abl融合mRNA，诊断一名患者为慢性期慢性髓性白血病（CML）。诊断后1个月，患者出现淋巴结髓外原始细胞危象，随后骨髓发生髓内原始细胞危象，其中显示出不同的表面标志物。给予BH-AC、VP16和米托蒽醌联合化疗；这导致淋巴结病迅速消失，恢复正常造血，细胞遗传学分析未检测到Ph1染色体。进行RT-PCR检测残留的Ph1克隆，结果显示虽然Ph1克隆被优先抑制，但仍有残留。强化化疗方案优先抑制了Ph1阳性克隆，并使该CML急变期患者达到临床和细胞遗传学缓解；我们认为RT-PCR是检测该疾病临床过程中微小残留病的一种敏感且有用的方法。
