慢性髓系白血病患者移植造血干细胞后bcr／abl融合基因变化的实时定量RT-PCR监测及其意义

为了探讨Ph阳性慢性髓系白血病（CML）患者异基因造血干细胞移植后不同时期bcr／abl融合基因水平变化的实时定量PCR监测及其意义，对21例CML患者骨髓移植后不同时期bcr／abl融合基因水平用实时定量PCR技术进行了连续监测。结果表明：21例bcr／abl融合基因阳性CML患者移植后7例未检测出融合基因，14例移植后1—6月仍可检出不同水平bcr／ab／融合基因。动态观察发现，9例bcr／abl融合基因处于较低水平，相对数在0．0074％～0．088％，于移植后第3—7月转为阴性。5例符合分子生物学复发标准，融合基因相对数在0．077％-75％。其中1例在骨髓移植后1、2、3个月融合基因相对数分别为0．95％、1．5％、0．16％，于移植后4个月自行转阴性；2例接受同一供者单个核细胞输注后bcr／abl转为阴性；2例发展为临床血液学复发，其中1例经化疗及同供者单个核细胞输注再次缓解，但bcr／abl阳性，另1例不治死亡。结论：对于ph阳性CML患者骨髓移植后连续定量监测bcr／abl融合基因水平可以了解疾病残留状态，预测分子学生物学复发，指导临床治疗，并评价疗效。

Detection of bcr/abl Fusion Gene Changes in Patients with Chronic Myeloid Leukemia after allo-HSCT by Real-time Quantitative Reverse Transcription Polymerase Chain Reaction and Its Significance

This study was aimed to detect the changes of bcr/able gene level in ph CML patients at different stages after allo-HSCT by real-time quantitative PCR and to evaluate the significance of this detection. The serial detection of bcr/abl fusion gene levels in 21 cases of CML treated with allo-HSCT was performed by RQ-PCR.The results showed that the bcr/able fusion gene could not be detected in 7 out 21 CML cases with positive fusion gene after allo-HSCT,while the bcr/abl fusion gene of different levels could be detected in 14 cases within 1-6 months.Dynamic detection indicated that the bcr/abl fusion gene levels in 9 cases were lower with relative value 0.0074%-0.088% and then could not be detected within 3-7 months after allo-HSCT.The bcr/abl fusion gene levels in 5 cases diagnosed as molecular relapse were between 0.077%-75%.The bcr/abl fusion gene levels in 1 out of 5 cases were 0.95%,1.5%,and 0.16% in month 1,2 and 3,respectively,and turned to negative in the month 4 without any treatment after allo-HSCT.2 cases received the donor peripheral blood stem cell infusion,and then their bcr/abl mRNA levels could not be detected in bone marrow.Another 2 cases developed to the hematologic relapse,1 out of 2 cases reached CR again after infusion of donor peripheral blood stem cells and chemotherapy,the other one died.It is concluded that serial quantifications of bcr/abl mRNA levels by RQ-PCR are reliable and can be used to detect the MRD,to monitor the outcome and to predict the relapse.