摘要：

Although molecular biologic techniques can now detect minimal numbers of cells in patients in complete clinical remission, the clinical significance of has never been conclusively established. If the detection of predicts which patients will relapse, then therapy could be altered based upon the detection of these cells. The t(14;18) can be detected by polymerase chain reaction () amplification in 50% of patients with and allows detection of one cell in up to 1 million normal cells. To determine the clinical significance of the detection of minimal residual cells in the bone marrow (BM) amplification was used to detect the presence of residual cells after autologous BM transplantation (ABMT) in serial BM samples from 134 patients with in whom a translocation could be detected. analysis was performed on a total of 542 BM samples obtained while these patients were in complete remission. Disease-free survival was markedly increased in patients with no -detectable cells in the marrow compared with those in whom residual cells were detected (P <.00001), and the presence of detectable cells was associated with a 48-fold increase in the risk of relapse. Of the 77 patients (57%) with no -detectable cells in their most recent BM sample, none have relapsed. In contrast, all 33 patients (25%) who have relapsed had -detectable cells detected in their BM before clinical relapse occurred. In 19 patients (14%), residual cells in the BM were detected early following transplantation and subsequently were no longer detectable, although these patients received no further therapy. In these patients, residual cells may already have been irreversibly damaged by the high-dose therapy or an endogenous immune mechanism may be capable of eliminating residual cells in some patients. Therefore, although the detection of by following ABMT in patients with identifies those patients at high risk of relapse, the presence of early after transplantation may not be associated with poor prognosis in a small subset of patients. Confirmatory studies will be required to determine more definitively the role of minimal disease detection to identify which patients require additional therapy.

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