目的探讨通过检测白血病细胞来源微粒(Me)BCR-ABL融合基因水平对达完全分子学反应(cMR)后慢性髓性白血病(CML)患者进行分层的可能。方法收集29例不同疾病状态的CML患者,采用实时定量PCR方法分别检测患者外周血细胞与MP中的BCR-ABLmRNA水平。结果患者外周血MP和细胞中均能稳定检测出BCR-ABLmRNA;CMR、主要分子学反应(MMR)、完全细胞遗传学反应(CCyR)三种疾病状态下患者MP中的BCR-ABLmRNA水平分别为9.1±2.8、25.2±4-6.9和62.8±6-3,差异具有统计学意义(P〈0.05);细胞内BCR-ABL转录本为阴性时,来源于同一份样本的MP仍可检测到BCR.ABLmRNA[中位水平6.5(3.7~15.3)];CMR患者MP中BCR—ABL融合基因水平与服药时间呈负相关(t=0.656,P〈0.05);在同样达到CMR的前提下,造血干细胞移植组患者和酪氨酸激酶抑制剂治疗组患者相比,MP中BCR.ABLmRNA水平更低(分别为3.3±2.1和9.14±2.8,P〈0.05)。结论CML患者外周血细胞来源MP中可以稳定检出BCR-ABLmRNA,并有望成为患者达CMR后继续监测的重要指标。
Objective To exam the role of leukemia cells-derived microparticles in the post- complete molecular response stratification. Methods Blood samples from 29 patients diagnosed with chronic myeloid leukemia (CML) were collected. Microparticles (MP) were extracted from the peripheral blood. Real-time PCR was performed to measure the level of BCR-ABL mRNA. Results BCR-ABL mRNA could be stably detected both in MP and peripheral blood cells; BCR-ABL in MP showed significant difference within complete molecular response, major molecular response and complete cytogenetic response (9.1~2.8,25.2~6.9 and 62.8~6.3 respectively, P 〈0.05). BCR-ABL was detected in MP even when it was negative in peripheral blood cells (3.7-15.3). For patients with complete molecular response, BCR-ABL in MP but not cells were significantly different between imatinib and stem cell transplant recipients (3.3~2.1 vs 9.1 ~2.8, P 〈0.05). Conclusion This study indicated that MP may serves as a new target for monitoring of CML. Quantification of BCR-ABL in MP may offer a novel strategy for Stratification of molecular response.