Evaluation of minimal residual disease using reverse-transcription polymerase chain reaction in t(8;21) acute myeloid leukemia: a multicenter study of 51 patients.
Evaluation of minimal residual disease using reverse-transcription polymerase chain reaction in t(8;21) acute myeloid leukemia: a multicenter study of 51 patients.
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DOI：
10.1200/jco.2000.18.4.788
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发表时间：
2000-02
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通讯作者：
F. Morschhauser;J. Cayuela;S. Martini;A. Baruchel;P. Rousselot;G. Socié;P. Berthou;J. Jouet;N. Straetmans;F. Sigaux;P. Fenaux;C. Preudhomme
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作者：
F. Morschhauser;J. Cayuela;S. Martini;A. Baruchel;P. Rousselot;G. Socié;P. Berthou;J. Jouet;N. Straetmans;F. Sigaux;P. Fenaux;C. Preudhomme
目的应用多种逆转录聚合酶链式反应(RT-PCR)技术检测AML1-ETO融合转录本是t(8；21)易位急性髓系白血病(AML)长期完全缓解(CR)的常见发现。然而，实验室间质量控制的更大规模的前瞻性研究对于更准确地研究在t(8；21)AML中用RT-PCR研究微小残留病的临床实用性可能是重要的。患者和方法我们收集了5个中心确诊的51例t(8；21)AML患者的223份骨髓标本，并在两个不同的实验室用两种不同的RT-PCR技术(套式技术和一步法，灵敏度分别为10(-6)和10(-5))进行检测。结果14例长期CR患者(中位随访期112个月)至少采集两次标本，两种方法均为阴性。37例患者在首次和/或第二次完全缓解后、强化巩固治疗前和治疗结束后每隔3至6个月采集样本。获得CR后，用一步法(60%)或两种方法(48%)转为PCR阴性的患者的CR持续时间比持续阳性的患者长(双侧对数列检验，P=0.0001)。强化巩固前用一步法转阴的患者(23%)复发率较低(11%比72%)，CR持续时间较长(双侧对数等级检验，P=0.0015)。结论长期缓解期t(8；21)AML患者均为阴性。在前瞻性研究的患者中，发现阴性的聚合酶链式反应结果与无复发之间有很好的相关性。在巩固治疗前，一步RT-PCR技术的早期阴性结果似乎具有特别好的预后，提示RT-PCR分析可以帮助选择t(8；21)AML患者的巩固治疗类型。
PURPOSE Most studies using various reverse-transcription polymerase chain reaction (RT-PCR) techniques reported that the detection of the AML1-ETO fusion transcript was a common finding in long-term complete remission (CR) in acute myeloid leukemia (AML) with t(8;21) translocation. However, larger prospective studies with interlaboratory quality control may be important to investigate more precisely the clinical usefulness of studying minimal residual disease with RT-PCR in t(8;21) AML. PATIENTS AND METHODS We collected 223 marrow samples from 51 patients with t(8;21) AML diagnosed in five centers and tested all samples by two different RT-PCR techniques (a nested technique and a one-step technique, with a sensitivity of 10(-6) and 10(-5), respectively) in two different laboratories. RESULTS Samples from 14 patients in long persistent CR (median follow-up duration, 112 months) were taken at least twice, and all were PCR-negative by both techniques. Samples were prospectively taken from 37 patients after achievement of first CR and/or second CR, before intensive consolidation treatment, and every 3 to 6 months after completion of therapy. Patients who converted to PCR negativity with the one-step technique (60%) or both techniques (48%) after CR achievement had a longer CR duration than those with persistently positive PCR results (two-sided log-rank test, P =.0001). Patients who became PCR-negative with the one-step technique before intensive consolidation (23%) had a lower relapse rate (11% v 72%) and a longer CR duration than those who remained persistently PCR-positive at that point (two-sided log-rank test, P =.0015). CONCLUSION Patients with AML with t(8;21) in long-term remission were all PCR-negative. In prospectively studied patients, a good correlation was found between negative PCR results and absence of relapse. Early negative results with the one-step RT-PCR technique, before consolidation treatment, seemed to carry an especially good prognosis, suggesting that RT-PCR analysis could help in choosing the type of consolidation therapy in patients with t(8;21) AML.