Detection of Residual Leukemic Cells in Adult Acute Lymphoblastic Leukemia by Analysis of Gene Rearrangements and Correlation with Early Relapses
Improvements in complete remission (CR) rate and long-term survival in adult acute lymphoblastic leukemia (ALL) have been achieved during the past decade by intensive chemotherapy. Today, more than 75% of the patients attain a CR (Hoelzer et al. 1984; Clarkson et al. 1985; Jacobs and Gale 1984). Nevertheless, the recurrence rate remains high. Only about 40% of patients are still alive and in CR after 5 years (Hoelzer et al. 1984; Clarkson et al. 1985; Jacobs and Gale 1984). Half of the relapses occur within the first year after the diagnosis has been established. Using multivariate analysis, patients can be categorized to be at high risk for relapse according the following criteria: high initial cell count, age over 35 years, null cell ALL immunophenotype, no CR after 4 weeks’ induction therapy (Hoelzer et al. 1984). Recurrent disease is probably due to residual leukemic cells. Gene rearrangements are used as markers of clonality and thereby monoclonal lymphoid cells can be detected with an high degree of sensitivity (Korsmeyer et al. 1983; Aisenberg and Wilkes 1985; Raghavachar et al. 1986). Even in bone marrow samples considered morphologically to be free from leukemic cells, analysis of gene rearrangements is still able to give evidence of persisting disease (Zehnbauer et al. 1986). In this study, we have applied the analysis of gene rearrangements to detect residual disease in patients considered to be in CR after a standardized induction therapy. The laboratory findings were correlated with the duration of clinical remission and the relapse rate. The aim of the study was to assess the influence of residual disease on the rate of early relapses in ALL.
KeywordsComplete Remission Acute Lymphoblastic Leukemia Minimal Residual Disease Gene Rearrangement Null Cell
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