BIOMED-2方法检测恶性淋巴瘤骨髓侵犯的基因重排研究

本研究探讨BIOMED-2方法检测非霍奇金淋巴瘤(NHL)患者骨髓中免疫球蛋白(IG)和T细胞受体(TCR)基因克隆性重排的可行性,并初步评价其临床价值。采用BIOMED-2系统检测73例NHL(B-NHL 55例,T-NHL 18例)患者骨髓中IGH、IGK、IGL基因和TCRβ、TCRγ、TCRδ基因的克隆性重排,与骨髓穿刺细胞形态学进行比较,评价其与病理特征、临床分期等的相关性。结果表明:73例NHL中31例检测出IG或TCR基因重排,阳性率42.5%,高于骨髓穿刺细胞形态学阳性率24.7%(18/73),差异具有统计学意义(p<0.05);其中B-NHL阳性率为40.0%(22/55),T-NHL阳性率为50.0%(9/18),两者差异无统计学意义(p>0.05)。PCR检测阳性率和AnnArbor分期相关,Ⅲ/Ⅳ期患者阳性率高于Ⅰ/Ⅱ期,差异具有统计学意义(p<0.05)。结论:BIOMED-2检测IG和TCR基因重排是判断淋巴瘤骨髓浸润的有效方法,比骨髓细胞形态学更为敏感,有助于临床分期、预后判断和治疗选择。PCR检测阳性率和Ann Arbor分期相关,与淋巴瘤恶性程度、年龄、治疗状态、有无B组症状及是否累及脾脏无关。

Detection of gene rearrangement in bone marrow of patients with non Hodgkin's lymphoma by BIOMED-2 protocols

This study was purposed to explore the feasibility of BIOMED-2 protocols for detection of immunoglobin (IG) and T-cell receptor (TCR) gene clonal rearrangement in bone marrow of Non-Hodgkin's lymphoma(NHL) patients, and to evaluate its clinical value. Gene clonal rearrangment (IGH, IGK, IGL, TCRβ, TCRγ, TCRδ) was detected by using BIOMED-2 protocols in 73 bone marrow examples of NHL patients. The PCR results were compared with the cytomorphologic examination of bone marrow. The correlation between PCR detection results and clinical stage, pathological factors were also evaluated. The results showed that clonal IG or TCR gene rearrangements were found in 31 of 73 cases (42.5%), higher than the positive rate of cytological analysis (24.7%, 18/73, p < 0.05). IG/TCR clonality rates were 40.0% (22/55) for B-NHL and 50% (9/18) for T-NHL. IG/TCR clonality rates detected in patients with III/IV stage were higher than those with I/II stage (p < 0.05). It is concluded that BIOMED-2 protocols are effective methods for detection of abnormalities in bone marrow in patients with lymphoma, and are superior to cytomorphologic examination. The positive rate of PCR detection is correlated with Ann Arbor stage, but is not related with malignant degree, age, treatment status, B symptoms or the involvement of spleen.