PCR‐positivity in harvested bone marrow predicts relapse after transplantation with autologous purged bone marrow in children in second remission of precursor B‐cell acute leukaemia

• Published in: British journal of haematology Vol. 96; no. 2; pp. 395 - 402
• Main Authors: VERVOORDELDONK, SUSAN F., MERLE, PAULINE A., BEHRENDT, HENK, STEENBERGEN, ERIC J., VAN DEN BERG, HENK, VAN WERING, ELISABETH R., KR. VON DEM BORNE, ALBERT E. G., VAN DER SCHOOT, C. ELLEN, VAN LEEUWEN, ELEONORE F., SLAPER‐CORTENBACH, INEKE C. M.
• Format: Journal Article
• Language: English
• Published: Oxford, U.K. and Cambridge, USA Blackwell Science Ltd 01-02-1997; Blackwell
• Subjects: acute lymphoblastic leukaemia; Adolescent; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; autologous bone marrow transplantation; Biological and medical sciences; Bone Marrow Purging; Bone Marrow Transplantation - methods; Bone marrow, stem cells transplantation. Graft versus host reaction; Child; Child, Preschool; Female; Forecasting; Humans; Male; Medical sciences; Polymerase Chain Reaction; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma - diagnosis; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma - therapy; purging; Recurrence; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation, Homologous; Treatment Outcome; Tumor Cells, Cultured; Human; Relapse; Transfusion; Prognosis; Purification; Acute; Minimal residual disease; CFU-BL-Cell; Malignant hemopathy; Polymerase chain reaction; Autograft; Treatment; Lymphoproliferative syndrome; Bone marrow; Graft; Remission; Acute lymphocytic leukemia; Molecular biology; Child
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1046/j.1365-2141.1997.d01-2018.x

Purging of autologous bone marrow (BM) grafts of children in second remission after a relapse of precursor B acute lymphoblastic leukaemia (ALL) in the BM has been carried out in our laboratory since 1987, initially by complement mediated cell lysis. This protocol was extended by performing an immunorosette depletion before lysis with complement. The aim of the present study was to assess by polymerase chain reaction the presence of residual leukaemic cells in the BM grafts before and after purging. The results were then correlated to clinical outcome. In 24/28 patients a PCR product was obtained by amplification of IgH and/or TcR junctional regions. BM before purging was available for analysis in 13 patients. We found that leukaemic cells could be detected in 8/13 (62%) of these grafts before purging . All these eight patients experienced a relapse, regardless of whether the purging procedure had been successful (defined as achievement of PCR‐negativity) or not. In contrast, none of the five patients with PCR‐negative grafts before purging relapsed (P = 0.0008). One patient died due to transplant‐related toxicity. Of the remaining 23 patients, nine patients received a PCR‐positive BM graft after purging. All these nine patients experienced a relapse as compared to 6/14 whose BM was PCR‐negative after purging (P = 0.0072). Two of eight PCR‐positive BM grafts could be purged to PCR‐negativity. Thus, improvements both in treatment of leukaemia and in purging efficacy are still needed.