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Blood, 15 March 2001, Vol. 97, No. 6, pp. 1560-1565
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Early detection of BCR-ABL transcripts by
quantitative reverse transcriptase-polymerase chain reaction predicts
outcome after allogeneic stem cell transplantation for chronic
myeloid leukemia
Eduardo Olavarria,
Edward Kanfer,
Richard Szydlo,
Jaspal Kaeda,
Katayoun Rezvani,
Kate Cwynarski,
Christopher Pocock,
Francesco Dazzi,
Charles Craddock,
Jane F. Apperley,
Nicholas C. P. Cross, and
John M. Goldman
From the Department of Haematology,
Hammersmith Hospital, Imperial College School of
Medicine, London, England.
The reverse transcriptase-polymerase chain reaction (RT-PCR) has
become widely used for monitoring minimal residual disease after
allogeneic stem cell transplantation (SCT) for chronic myeloid leukemia
(CML). However, most of these studies were performed using qualitative
RT-PCR, and the interpretation of the results obtained has been
conflicting. The correlation of a quantitative RT-PCR test
performed early after SCT (at 3 to 5 months) and long-term outcome of
CML patients surviving for more than 6 months was studied. Between January 1991 and June 1999, data from 138 CML patients who received allografts were evaluated. Early RT-PCR results were classified as (1) negative if there were no BCR-ABL
transcripts detected (n = 61), (2) positive at low level if the total
number of BCR-ABL transcripts was less than 100 per µg
RNA and/or the BCR-ABL/ABL ratio was less than
0.02% (n = 14), or (3) positive at high level if transcript levels
exceeded the thresholds defined above (n = 63). Three years after SCT
the cumulative incidence of relapse was 16.7%, 42.9%, and 86.4%,
respectively (P = .0001). The relationship between
BCR-ABL transcript level and probability of relapse was
apparent whether patients had received sibling or unrelated donor SCT
and also whether or not the transplantation was T cell depleted. The
results suggest that quantitative RT-PCR performed early after SCT is
useful for predicting outcome and may help to define the need for
further treatment.

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