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.

译文

尽管同种异体骨髓移植 (BMT) 可以成功治疗慢性粒细胞白血病 (CML),但白血病复发仍然是一个重要的临床问题。移植后骨髓的分子监测可用于预测复发,特别是在费城染色体或其分子对应物的CML患者中,bcr-abl融合信使RNA可用作最小残留疾病 (MRD) 的白血病特异性标志物。我们已经连续研究了18例临床和血液学患者的嵌合体 (使用短串联重复序列的聚合酶链反应 (str-pcr)) 和MRD状态 (使用bcr-abl融合mRNA的逆转录酶PCR) 慢性期CML的同种异体BMT后缓解。11例患者表现出完全的供体嵌合体,没有最小残留疾病的证据。5例患者有短暂或低水平稳定的MC。在两名T细胞耗尽CML BMT后复发> 6年的患者中观察到晚期MC和MRD。因此,在CML患者的移植后环境中,STR-PCR是一种适当的筛查测试,但是那些表现出混合造血嵌合体的患者也应使用白血病特异性敏感分子测定法进行监测。

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