Stem cell transplantation in poor-risk chronic lymphocytic leukemia: assessment of post-transplant minimal residual disease using four- and six-color flow cytometry and allele-specific RQ-PCR |
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Authors: | Itälä Maija Huhtinen Anna-Riina Juvonen Vesa Kairisto Veli Pelliniemi Tarja-Terttu Penttilä Tarja-Leena Rauhala Auvo Tienhaara Anri Remes Kari |
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Affiliation: | Department of Medicine, Turku University Central Hospital, Turku, Finland;;TYKSLAB, Turku University Central Hospital, Turku, Finland;;Department of Medicine, Vaasa Central Hospital, Vaasa, Finland |
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Abstract: | A total of 178 bone marrow samples were taken for minimal residual disease (MRD) analysis after 34 stem cell transplantations for poor-risk chronic lymphocytic leukemia, and 86 of them were analyzed in parallel by flow cytometry and allele-specific oligonucleotide-PCR (ASO-PCR). ASO primer was successfully designed for all patients whose frozen diagnosis samples were available. Flow cytometry and ASO-PCR were concordant, i.e. both either positive or both negative, in 78% of the analyses. Flow cytometry did not detect MRD in any of the samples that were PCR-negative cases. In contrast, ASO-PCR detected MRD in samples that were negative for MRD by flow cytometry in 22% of the analyses. In one patient, the immunophenotype but not the IgVH gene sequence had changed during a course of the disease, and MRD could not be followed by flow cytometry. In the remaining cases, the discrepancy was due to a higher sensitivity of ASO-PCR. Autologous stem cell transplantation resulted in clinical complete response in 87% (20/23) of the patients. By flow cytometry, 35% (8/23) of autotransplanted patients became MRD-negative, but only 12.5% (2/16) PCR-negative (sensitivity of ASO-PCR <0.001 and <0.01, respectively). All allotransplanted patients achieved or maintained hematological CR, and five out of nine patients (56%) became PCR-negative (sensitivity of PCR between <0.001 and <0.003), two of them having non-myeloablative conditioning. None of the patients who became PCR-negative after allogeneic transplantation have relapsed. |
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Keywords: | chronic lymphocytic leukemia minimal residual disease flow cytometry polymerase chain reaction allele-specific oligonucleotide-polymerase chain reaction autologous stem cell transplantation allogeneic stem cell transplantation |
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