B-cell reconstitution after allogeneic SCT impairs minimal residual disease monitoring in children with ALL

Bone Marrow Transplant. 2008 Aug;42(3):187-96. doi: 10.1038/bmt.2008.122. Epub 2008 May 19.

Abstract

Minimal residual disease (MRD) detection using quantification of clone-specific Ig or TCR rearrangements before and after transplantation in children with high-risk ALL is an important predictor of outcome. The method and guidelines for its interpretation are very precise to avoid both false-negative and -positive results. In a group of 21 patients following transplantation, we observed detectable MRD positivities in Ig/TCR-based real-time quantitative PCR (RQ-PCR) leading to no further progression of the disease (11 of 100 (11%) total samples). We hypothesized that these positivities were mostly the result of nonspecific amplification despite the application of strict internationally agreed-upon measures. We applied two non-self-specific Ig heavy chain assays and received a similar number of positivities (20 and 15%). Nonspecific products amplified in these RQ-PCR systems differed from specific products in length and sequence. Statistical analysis proved that there was an excellent correlation of this phenomenon with B-cell regeneration in BM as measured by flow cytometry and Ig light chain-kappa excision circle quantification. We conclude that although Ig/TCR quantification is a reliable method for post transplant MRD detection, isolated positivities in Ig-based RQ-PCR systems at the time of intense B-cell regeneration must be viewed with caution to avoid the wrong indication of treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • B-Lymphocytes / immunology*
  • Burkitt Lymphoma / surgery*
  • Child, Preschool
  • DNA, Neoplasm / genetics
  • Gene Rearrangement
  • Humans
  • Infant
  • Lymphocyte Transfusion
  • Male
  • Neoplasm, Residual / diagnosis
  • Neoplasm, Residual / genetics
  • Oligonucleotide Array Sequence Analysis
  • Polymerase Chain Reaction
  • Stem Cell Transplantation
  • Transplantation, Homologous / immunology*

Substances

  • DNA, Neoplasm