定量检测bcr-abl mRNA在慢性粒细胞白血病患者异基因造血干细胞移植后的意义  

Significance of Quantitative Detection of bcr-abl mRNA in Chronic Myeloid Leukemia Patients after Allogeneic Hematopoietic Stem Cell Transplant

作　　者：耿素霞[1] 杜欣[1] 翁建宇[1] 李其辉[1] 苏健华[2] 林秋雄[2] 李扬秋[3] 

机构地区：[1]广东省人民医院血液科,广州510080 [2]广东省人民医院医学研究中心,广州510080 [3]暨南大学医学院血液病研究所,广州510632

出　　处：《中国实验血液学杂志》2007年第5期993-997,共5页Journal of Experimental Hematology

摘　　要：本研究确切了解CML患者异基因造血干细胞移植后bcr-abl mRNA的变化情况,为临床诊断早期复发提供实验依据。用实时荧光定量PCR方法检测15例慢性粒细胞白血病(CML)患者异基因造血干细胞移植前后78份外周血和骨髓标本的bcr-abl mRNA水平。结果表明,移植前患者的bcr-ablmRNA水平较高,中位数为29.303%;移植后1个月时检测bcr-abl mRNA水平较移植前大幅度降低,中位数为0;移植后1年内,连续多次检测bcr-abl mRNA水平,变化模式不一致,但6个月后的总体水平较6个月前明显降低,移植1年以上的受者绝大多数bcr-abl mRNA检测不到,或偶可检测到,但水平极低(0.007%、0.004%和0.021%),所检测受者的骨髓和外周血像均正常;同期骨髓与外周血bcr-abl水平无明显差异,且变化趋势一致。结论:CML患者移植后早期bcr-abl水平变化起伏较大,连续动态检测可明确其变化趋势,有助于判断移植效果、指导临床治疗,但6个月前检测到bcr-abl存在并不提示疾病复发;检测外周血bcr-abl或许更适于临床上对患者的随访。The objective of this study was to analyze the level of bcr-abl mRNA in peripheral blood （ PB ） after allogeneic stem cell transplantation （allo-SCT） in chronic myeloid leukemia patients, providing a experimental basis for diagnosing early relapse, bcr-abl mRNA levels in 78 PB and bone marrow （BM） samples from 15 CML patients after allo- SCT were detected by using real-time quantitative PCR. The results indicated that levels of bcr-abl mRNA before transplantation were high （ median 29.303% ） and decreased greatly （ median 0） at the first month after allo-SCT. During the first year after allo-SCT, the patterns of serial bcr-abl transcripts varied in number, but the overall bcr-abl transcript levels significantly decreased at 6 months after allo-SCT. Majority of patients with undetectable or very low levels of bcr-abl mRNA were monitored after 1 year following transplantation. The hematological features of BM and PB in all detected patients remained normal. PB and BM bcr-abl values were not different significantly and had the similar trend of changes. It is concluded that the bcr-abl mRNA levels in CML patients change greatly early after allograft. Serial monitoring measurements for bcr-abl mRNA contribute to understanding the trend of change and effect of transplantation, also can be a guidance for starting therapy. But detectable levels of bcr-abl mRNA during the first 6 months do not indicate relapse. Measurements of bcr-abl mRNA of PB may be more suitable for routine monitoring long-term disease status in CML after allo-HSCT.

关 键 词：慢性粒细胞白血病 bcr—abl融合基因 实时定量PCR 微小残留病变 

分 类 号：R733.72[医药卫生—肿瘤]