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Acute promyelocytic leukemia: clinical relevance of two major PML-RAR alpha
isoforms and detection of minimal residual disease by
retrotranscriptase/polymerase chain reaction to predict relapse
W Huang, GL Sun, XS Li, Q Cao, Y Lu, GS Jang, FQ Zhang, JR Chai, ZY Wang and S Waxman
Laboratory of Molecular Biology, Shanghai Institute of Hematology, China.
Recent data have shown that the PML-RAR alpha fusion gene resulting from
translocation t(15;17) is a highly reliable molecular marker of acute
promyelocytic leukemia (APL). In this study performed on 97 Chinese
patients with APL, the retrotranscriptase/polymerase chain reaction
(RT/PCR) was used to evaluate the clinical relevance of the long (L) or
short (S) PML-RAR alpha fusion mRNA isoforms and to study minimal residual
disease during clinical remission (CR). There were more early deaths during
the all-trans retinoic acid (ATRA) induction treatment and more relapses
within 2 years of CR in the S-type (6 of 19 cases) than in the L-type group
(2 of 33 cases) (P < .025). Among 12 cases analyzed before and after the
ATRA-induced CR, 9 cases (75%) showed positive RT/PCR, whereas only 3 cases
showed a negative result, justifying the need for chemotherapy after
ATRA-induced CR. Eleven of 62 APL patients in CR, after ATRA-induced CR and
chemotherapy consolidation (follow-up, from 3 to 72 months), showed
positive RT/PCR. Five of them relapsed within 1 to 6 months after the
positive test; one converted to negative after further chemotherapy; and 5
remained in CR status without further PCR data. However, the latter 5 cases
all received further intensive consolidation therapy after the PCR
positivity. These results show that a positive RT/PCR of PML-RAR alpha is a
sensitive predictor of relapse in APL.
Volume 82,
Issue 4,
pp. 1264-1269,
08/15/1993
Copyright © 1993 by The American Society of Hematology
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