多重PCR法检测初诊成人急性淋巴细胞白血病患者克隆性免疫球蛋白和T细胞受体基因重排

目的 应用多莺PCR方法检测初诊成人急性淋巴细胞白血病(ALL)患者的克隆性免疫球蛋白(Ig)和T细胞受体(TCR)基因重排,为实时定量RT-PCR(RQ-PCR)法监测ALL患者体内的微量残留病(MRD)奠定基础.方法 参照BIOMED-2协作组制定的Ig和(或)TCR检测方法,设计96条不同的PCR引物,分成14个混合管,通过多重PCR,分别检测患者骨髓单个核细胞的IgH、IgK、TCRB、TCRG、TCRD克隆性基因重排.结果 在22例成人B系ALL患者中,Ig克隆性重排检出率为96%,其中IgH为86%,IgK为14%.在18例成人T系ALL患者中,TCR克隆性重排检出率为100%,其中TCRB为83%,TCRG为78%,TCRD为39%.两个及两个以上克隆性标志物的检出率在B和T系ALL中分别为91%(22例中20例)和89%(18例中16例).结论 BIOMED-2协作组设计的14管多重PCR引物和方法,几乎可检测到淋巴细胞白血病患者体内所有占优势的克隆性T、B细胞增殖群体,方法简便、可靠、覆盖面广,适用于成人ALL患者基因重排检测和MRD监测.

Detection of clonal immunoglobulin and T-cell receptor gene rearrangements in newly diagnosed adult patients with acute lymphoblastic leukemia by using multiplex PCR protocols

Objective To provide the evidence of RQ-PCR-based assessment of minimal residual disease(MRD), the clonal immunoglobulin and T-cell receptor (Ig/TCR) gene rearrangements were identified in newly diagnosed adult patients with acute iymphoblastic leukemia (ALL) by multiplex PCR protocols. Methods Forty newly diagnosed adult patients with B-lineage(B-) and T cell (T-) ALL were involvled in this study. All DNA samples were obtained from the bone marrow (BM) mononuclear cells(MNC). IgH、 IgK ,TCRB,TCRG and TCRD gene rearrangements were detected by BIOMED-2 multiplex PCR protocols, which included 96 different primers and 14 multiplex PCR tubes. Results The clonal immunoglobulin(Ig) rearrangements were found in 96% of B- ALL, 86% being IgH and 14% IgK. While in T-ALL, clonal TCR rearrangements were found in all of the patients, 83% being TCRB ,78% TCRG and 39% TCRD. More than two clonal markers were found in 91% of B- ALL and 89% of T- ALL patients. Conclusions The detection rate of clonal rearrangements using the BIOMED-2 14 multiplex PCR tubes is unprecedentedly high, which can detect virtually all clonal B and T-cell proliferations. It can be used for diagnostic cionality studies as well as for the identification of PCR targets suitable for the detection of minimal residual disease.