Residual leukaemia after bone marrow transplant in children with acute lymphoblastic leukaemia after first haematological relapse or with poor initial presenting features.
Residual leukaemia after bone marrow transplant in children with acute lymphoblastic leukaemia after first haematological relapse or with poor initial presenting features.
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首次血液学复发或初始表现不佳的急性淋巴细胞白血病儿童骨髓移植后残留白血病。
DOI：
10.1046/j.1365-2141.2003.04135.x
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发表时间：
2003
影响因子：
6.5
通讯作者：
Zipf,TheodoreF
中科院分区：
文献类型：
--
作者：
Bunin,Nancy;Johnston,DennisA;Roberts,WMark;Ouspenskaia,MaiaV;Papusha,VictorZ;Brandt,MarkA;Zipf,TheodoreF
儿童急性淋巴细胞白血病（ALL）异基因骨髓移植（BMT）后复发是治愈的主要障碍。通过了解显微镜下检测不到的白血病的移植后行为和预测即将发生的复发的能力，可以加快移植后复发的挽救治疗的发展。我们使用定量聚合酶链反应方法（灵敏度为5·0 × 10 - 6）来测量预处理方案前和移植后五个时间点的残留白血病。 总共有18例ALL移植患者在第一次或第二次缓解时接受了为期1年的研究 ：在BMT后的第一年，12例仍处于缓解状态，4例血液学复发，1例皮肤复发，1例死于严重的移植物抗宿主病。血液学复发患者的白血病特异性免疫球蛋白重链（IgH）基因重排的移植后水平与保持缓解的患者显著不同。保持缓解的患者的水平随时间降低，尽管偶尔会增加，与测量测定的已知标准差一致。相比之下，所有临床复发之前的水平迅速增加。这种增长的速度和时间都是可变的。这些结果表明，残留白血病测量可用于指导移植后干预并测量其效果。
Relapse is the major obstacle to cure for children with acute lymphoblastic leukaemia (ALL) after allogeneic bone marrow transplant (BMT). Development of salvage therapy for post‐transplant relapse could be expedited by understanding the post‐transplant behaviour of microscopically undetectable leukaemia and the ability to predict impending relapse. We have used a quantitative polymerase chain reaction method (sensitivity of 5·0 × 10−6) to measure residual leukaemia before the conditioning regimen, and at five time‐points after transplantation. In total, 18 patients with ALL transplanted in first or second remission were studied for 1 year: For the first year post BMT, 12 remained in remission, four had haematological relapses, one had a cutaneous relapse, and one died of severe graft‐versus‐host disease. The post‐engraftment levels of the leukaemia‐specific immunoglobulin heavy (IgH) chain gene rearrangement for patients with haematological relapses were significantly different from those who remained in remission. The levels for the patients who remained in remission decreased with time, although there were occasional increases consistent with the known standard deviation of the measurement assay. In contrast, all clinical relapses were preceded by a rapid increase in levels. Both the rate of this increase and its timing were variable. These results suggest that residual leukaemia measurements can be used to direct post‐transplant interventions and measure their effects.