Serial measurement of BCR-ABL transcripts in the peripheral blood after allogeneic stem cell transplant for chronic myeloid leukemia: an attempt to define patients who may not require further therapy

Kaeda, Jaspal, O'shea, Derville, Szydlo, Richard M., Olavarria, Eduardo, Dazzi, Francesco, Marin, David, Saunders, Susan, Khorashad, Jamshid S., Cross, Nicholas C.P., Goldman, John M. and Apperley, Jane F. (2006) Serial measurement of BCR-ABL transcripts in the peripheral blood after allogeneic stem cell transplant for chronic myeloid leukemia: an attempt to define patients who may not require further therapy. Blood, 107 (10), 4171-4176. (doi:10.1182/blood-2005-08-3320).

Abstract

We identified 243 patients with Ph-positive CML who had BCR-ABL transcripts monitored by quantitative RT-PCR after allogeneic stem cell transplant for a median of 84.3 months. Individual patients were regarded as having achieved molecular relapse (MR) if the BCR-ABL/ABL ratio exceeded 0.02% on three occasions or reached 0.05% on two occasions. Patients were allocated to one of four categories: (1) 36 patients were 'persistently negative' or had a single low level positive result, (2) 51 patients, 'fluctuating positive, low level', had more than one positive result but never more than two consecutive positive results; (3) 27 patients, 'persistently positive, low level', had persisting low levels of BCR-ABL transcripts but never more than three consecutive positive results, and (4) 129 patients relapsed. In 107 of these relapse was based initially only on molecular criteria; in 72 (67.3%) patients the leukemia progressed to cytogenetic or hematologic relapse either prior to or during treatment with donor lymphocyte infusions. We conclude that the pattern of BCR-ABL transcript levels after allograft is variable; only a minority of patients with fluctuating or persistent low levels of BCR-ABL transcript satisfied our definitions of MR whereas the majority of patients who did so were likely to progress further.

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Contributors

Author: Nicholas C.P. Cross

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