Perego R A, Marenco P, Bianchi C, Cairoli R, Urbano M, Nosari A M, Muti G, Morra E, Del Monte U
Institute of General Pathology, University of Milano, Italy.
Leukemia. 1996 Feb;10(2):207-12.
The translocation t(15;17)(q24;q21), unique to acute promyelocytic leukemia (APL), gives rise to PML/RAR alpha fusion transcripts detected by the sensitive reverse transcriptase-polymerase chain reaction (PCR) technique. PCR may help in the diagnosis and in monitoring minimal residual disease. Reversion of PCR to negative is obtained by chemotherapy (CT) alone or in combination with all-trans retinoic acid (ATRA). Here we show a serial PCR study of 10 APL cases. Five cases were studied at the time of diagnosis, and all were PCR positive for the rearranged transcripts (three bcr1 type, two bcr3 type). Seven cases in complete remission (CR) after one cycle of induction CT were persistently PCR negative, one case in CR after ATRA rescue was persistently PCR positive (bcr1 type), one patient (bcr3 type) relapsed 15 months after the PCR-negative CR and one patient died early. Seven patients underwent bone marrow transplantation (BMT) (five allogeneic, two autologous). One of them died early after take of the allogeneic BMT, the other six cases studied by serial PCR were persistently negative. At a median follow-up of 31 months (range 9-39), none of these six cases had relapsed. PCR data characterize the CR at the molecular level and evaluate the efficacy of different treatments, including BMT. The data may help to define a standardized schedule for PCR follow-up, and are also potentially useful to establish the time required before judging patients with persistently negative PCR to be cured. BMT as post-induction treatment in first CR is also discussed.
急性早幼粒细胞白血病（APL）特有的t(15;17)(q24;q21)易位会产生通过灵敏的逆转录酶 - 聚合酶链反应（PCR）技术检测到的PML/RARα融合转录本。PCR有助于诊断和监测微小残留病。单独化疗（CT）或联合全反式维甲酸（ATRA）可使PCR结果转为阴性。在此，我们展示了对10例APL病例的系列PCR研究。5例在诊断时进行了研究，所有病例重排转录本的PCR检测均为阳性（3例bcr1型，2例bcr3型）。诱导化疗一个周期后完全缓解（CR）的7例病例PCR持续阴性，1例经ATRA挽救后CR的病例PCR持续阳性（bcr1型），1例患者（bcr3型）在PCR阴性的CR后15个月复发，1例患者早期死亡。7例患者接受了骨髓移植（BMT）（5例同种异体，2例自体）。其中1例在同种异体BMT后早期死亡，通过系列PCR研究的其他6例病例持续阴性。在中位随访31个月（范围9 - 39个月）时，这6例病例均未复发。PCR数据在分子水平上表征CR并评估不同治疗方法（包括BMT）的疗效。这些数据可能有助于确定PCR随访的标准化方案，对于判断PCR持续阴性的患者何时治愈所需的时间确定也可能有潜在帮助。还讨论了BMT作为首次CR后诱导治疗的情况。
