Gardiner N, Lawler M, O'Riordan J, De'Arce M, McCann S R
Department of Haematology/Oncology St James Hospital, Dublin, Ireland.
Leukemia. 1997 Apr;11 Suppl 3:512-5.
Although Chronic Myeloid Leukaemia (CML) can be treated successfully with allogeneic bone marrow transplantation (BMT), leukaemia relapse remains a significant clinical problem. Molecular monitoring of the post transplant marrow can be useful in predicting relapse particularly in CML patients where the Philadelphia chromosome or its molecular counterpart, the BCR-ABL fusion messenger RNA can be used as a leukaemia specific marker of minimal residual disease (MRD). We have investigated chimaerism (using polymerase chain reaction of short tandem repeat sequences (STR-PCR)) and MRD status (using reverse transcriptase PCR of the BCR-ABL fusion mRNA) in a serial fashion in 18 patients who were in clinical and haematological remission post allogeneic BMT for chronic phase CML. Eleven patients exhibited complete donor chimaerism with no evidence of minimal residual disease. Five patients had transient or low level stable MC. Late MC and MRD was observed in two patients who relapsed > 6 years after T cell depleted BMT for CML. Thus STR-PCR is an appropriate screening test in the post transplant setting for CML patients, but those patients exhibiting mixed haemopoietic chimaerism should also be monitored using a leukaemia specific sensitive molecular assay.
尽管慢性粒细胞白血病（CML）可通过异基因骨髓移植（BMT）成功治疗，但白血病复发仍是一个重大的临床问题。移植后骨髓的分子监测有助于预测复发，特别是在CML患者中，费城染色体或其分子对应物BCR-ABL融合信使核糖核酸可作为微小残留病（MRD）的白血病特异性标志物。我们对18例慢性期CML异基因BMT后处于临床和血液学缓解期的患者进行了系列研究，检测了嵌合状态（使用短串联重复序列聚合酶链反应（STR-PCR））和MRD状态（使用BCR-ABL融合信使核糖核酸的逆转录酶PCR）。11例患者表现为完全供体嵌合，无微小残留病证据。5例患者有短暂或低水平稳定的混合嵌合。2例在T细胞去除的CML BMT后6年以上复发的患者出现晚期混合嵌合和MRD。因此，STR-PCR是移植后CML患者合适的筛查试验，但对那些表现为混合造血嵌合的患者，也应使用白血病特异性敏感分子检测进行监测。
