应用RT-nest-PCR法检测慢性髓细胞白血病非亲缘异基因骨髓移植后微小残留病变  

Detection of minimal residual disease after unrelated donor allogeneic bone marrow transplantation in chronic myeloid leukemia with nested reverse transcriptase polymerase chain reaction

作　　者：薛军[1] 王云贵[2] 黄河[2] 林茂芳[2] 

机构地区：[1]南京医科大学附属南京第一医院血液科,南京210006 [2]浙江大学医学院附属一院骨髓移植中心

出　　处：《临床血液学杂志》2007年第2期93-95,共3页Journal of Clinical Hematology

摘　　要：目的:应用筑巢式RT—PCR(RT—nest—PCR)法检测慢性髓细胞性白血病(CML)患者非亲缘异基因骨髓移植(URD)后微小残留病变(MRD),并探讨它与复发的相关性。方法:分别采用RT-nest-PCR法和常规细胞遗传学方法检测bcr／abl融合基因和Ph染色体。结果:20例CML行URD患者术前Ph染色体和bcr／abl融合基因检测均为阳性,移植术后30 d Ph染色体皆转为阴性,bcr／abl融合基因完全转阴时间为1～3个月,中位时间2个月;在随防的18例CML患者中,有16例患者bcr／abl融合基因完全转阴后没再转为阳性。在1例复发的CML患者中可见到血型、Ph染色体和bcr／abl融合基因动态变化,另1例CML患者在移植成功后的21个月和36个月检测到bcr／abl融合基因,经随访未见临床和血液学复发征象。结论:检测ber／abl融合基因是目前观察CML患者非亲缘异基因骨髓移植后微小残留病变最敏感的方法之一,非亲缘异基因骨髓移植能最大限度地消除CML患者体内残留病变,患者能长期无病生存。Objective： To detect minimal residual disease （MRD） after unrelated donor allogeneic bone marrow transplantation （URD-BMT） in chronic myeloid leukemia （CML） with nested reverse transcriptase polymerase chain reaction （RT-nest-PCR） in order to explore its relationship with relapse. Method tBcr/abl fusion gene and Ph chromosome were assayed by RT-nest-PCR and routine cytogenetic analysis, respectively. Result： Bcr/abl fusion gene and Ph chromosome were positive in 20 CML patients prior URD-BMT, Ph chromosome was negative after 30 days post URD-BMT. Bcr/abl fusion gene was completely reverted to negativity for the longest three months and the shortest one month, median time was two months; In 16 of follow-up＇s 18 CML cases, bcr/abl fusion gene persisted in negatively after reversed negatively. The blood type, Ph chromosome and bcr/abl fusion gene had changed continuously in one relapsed CML patient, In another CML case, bcr/abl fusion gene was detected in 21th month and 36th month after transplanted. The clinical hematological relapsed sign was not found by long term follow-up. Conclusion： Bcr/abl fusion gene detection method is so far one of the most sensitive method for MRD in CML after URD-BMT. URD-BMT could mostly eliminate MRD. The patients could remain in prolonged disease free survival.

关 键 词：白血病 髓细胞性 BCR/ABL融合基因 筑巢式逆转录聚合酶链反应 非亲缘异基因骨髓移植 微小残留病变 PH染色体 

分 类 号：R733.72[医药卫生—肿瘤]