B-NHL患者骨髓和外周血细胞克隆性IgH基因重排的检测及临床意义  

The Detection of Clonal IgH Gene Rearrangement in Bone Marrow and Peripheral Blood from B-NHL Patients and Its Clinic Significance

作　　者：李振玲[1] 沈悌[1] 郦筱能[2] 陈杰[1] 王书杰[1] 徐韶华[2] 葛昌文[1] 武永吉[1] 

机构地区：[1]中国医学科学院 [2]中日友好医院血液科,北京100029

出　　处：《中国实验血液学杂志》2001年第2期135-138,共4页Journal of Experimental Hematology

摘　　要：为探讨骨髓 (BM )和外周血 (PB)细胞克隆性免疫球蛋白重链 (IgH)基因重排在B细胞非霍奇金淋巴瘤 (B NHL)分期、疗效及预后判断方面的价值 ,采用半巢式PCR ,对治疗前B NHL患者BM 4 6例和PB 38例及治疗缓解后的BM和PB 10例进行了该标志的检测。对照组为非肿瘤或非B细胞来源肿瘤患者的BM或PB共 33例。结果显示 :在B NHL组 ,治疗前形态学有瘤细胞侵犯的 3例BM及 2例PB ,克隆性IgHCDR3重排阳性 ;在形态学未见异常的BM和PB中克隆性IgH重排阳性率分别为 6 5 .1%及 4 4.4 % ,与B NHL分期及有无全身症状无关。 10例病理组织克隆性IgH重排阳性的病人 ,7例缓解后BM和PB重排转为阴性 ,处于持续完全缓解状态 ;2例行自体外周血干细胞移植后BM或PB重排持续阳性者复发 ;1例移植后 10个月BM克隆性IgH重排阳性 ,仍处于完全缓解。对照组 33例中仅 1例克隆性IgH重排阳性 ,本方法的特异性为 97%。研究提示 ,PCR法能早期诊断BM及PB的瘤细胞浸润。临床缓解期BM或PB克隆性IgH重排阳性预示可能近期复发 ,阴性者可能持续缓解 ,个别IgH阳性者仍长期生存 。To evaluate the significance of bone marrow(BM) and peripheral blood(PB) cells with clonal gene rearrangement of the third complementary determining region of immunoglobulin heavy chain (IgHCDR3) in the diagnosis, clinical staging, determination of treatment effects and prediction of relapse in B NHL, clonal IgH gene rearrangement of BM from 46 and PB from 38 cases with B NHL were tested by semi nested polymerase chain reaction (SnPCR) and polyacrylamide gel electrophoresis before treatment, and ten of them were tested in complete remission after treatment. Results showed that this method was applicable to detecting one clonal IgHCDR3 gene rearrangement positive cell from up to 1 000 normal cells. Specificity of detection was 97%. Clonal IgHCDR3 rearrangement was shown in all 3 cases of BM and 2 of PB specimens with morphologic involvement. The clonal IgHCDR3 was detected in 65.1% of the BM and 44.4% of the PB without morphologic involvement in untreated patients with B NHL, independent of Ann Arbor staging and systemic symptoms. In 10 cases of B NHL with clonal IgHCDR3 rearrangement in diagnostic tissues, the molecular marker became negative in 7 patients who entered and remained in complete remission. Two cases relapsed in whom clonal IgHCDR3 rearrangements were detected in serial samples of BM or PB after autologous PBSCT. One patient in whom clonal IgHCDR3 rearrangement was detected at 10 months post PBSCT remained in complete remission up to now. It was concluded that clonal IgHCDR3 gene rearrangements were found in BM and PB from B NHL patients without morphologic abnormality. Persistence of molecular marker positive may be associated with relapse for patients in complete remission, and the patients without clonal IgHCDR3 rearrangement will be in continuous complete remission. Little is known about a few patient who was a long term disease free survivor despite the presence of PCR IgH rearrangement in the marrow.

关 键 词：B细胞非霍奇金淋巴瘤 骨髓 外周血 免疫球蛋白重链基因重排 

分 类 号：R733.1[医药卫生—肿瘤]