MINIMAL RESIDUAL DISEASE IN CHRONIC MYELOID-LEUKEMIA IN LONG SURVIVING PATIENTS FOLLOWING ALLOGENEIC BONE-MARROW TRANSPLANTATION

BACKGROUND: The study of the minimum residual disease in a series of patients diagnosed with chronic myeloid leukemia (CML) treated with non manipulated allogeneic bone marrow transplantation (BMT) reporting a survival longer than 6 months is presented. METHODS: The positivity of the chimeric transcription bcr-abl was studied In 18 long surviving BMT patients. The complementary DNA (cDNA) corresponding to this transcription was amplified by the polymerase chain reaction (PCR) technique. Double internal PCR (PCR nested) was performed to Increase the sensitivity of the determination. RESULTS: The first determination was performed in different post BMT stages with a median of 27 months (4-97). Fourteen out the 18 patients were positive for the bcr-abl transcription. On the second determination carried out In 11 cases with a sample obtained 24 months after the first 7 out of the 10 positive cases evaluated presented an identical pattern while the patient who originally was negative, remained so. The original transcription became negative in three patients. Only one of the positive cases developed hematologic relapse during the study period. CONCLUSIONS: Aggressive chemo-radiotherapy does not erradicate the leukemic clone In all patients with chronic myeloid leukemia. The persistence of positive results In a high number of patients with chronic myeloid leukemia in remission for over 6 months after bone marrow transplantation Is not predictive of imminent relapse.