Document Detail

Minimal residual disease in childhood B-lineage lymphoblastic leukemia. Persistence of leukemic cells during the first 18 months of treatment.
MedLine Citation:
PMID:  2095753     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Whether patients in clinical remission for acute lymphoblastic leukemia (ALL) continue to harbor leukemic cells is not known, because methods of detecting residual malignant cells have not been sufficiently sensitive. This information might be useful for predicting recurrence and determining the duration of therapy. METHODS: Using a sensitive new method--identifying complementarity-determining region III sequences with the polymerase chain reaction--we estimated the number of residual leukemic cells in the bone marrow of eight children with B-lineage lymphoblastic leukemia before and after remission. RESULTS: Induction chemotherapy produced a 3-to-4-log reduction in the number of leukemic cells. In all samples obtained up to 18 months after diagnosis, however, 0.004 to 2.6 percent of bone marrow nucleated cells were residual leukemic cells. Among the four patients studied more than 18 months after diagnosis, three had no detectable leukemic cells in marrow samples. Despite this, one of them, who was no longer receiving therapy, had a central nervous system relapse. In one patient receiving maintenance chemotherapy, there was a 60-fold increase in leukemic cells three months before bone marrow relapse. CONCLUSIONS: The complete disappearance of leukemic cells (or their reduction below our method's threshold of detection, 1 in 100,000 cells) may be necessary to achieve a cure of ALL. The quantification of residual leukemic cells in serial marrow aspirates during therapy may allow the early detection of relapse.
M Yamada; R Wasserman; B Lange; B A Reichard; R B Womer; G Rovera
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The New England journal of medicine     Volume:  323     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1990 Aug 
Date Detail:
Created Date:  1990-08-30     Completed Date:  1990-08-30     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  448-55     Citation Subset:  AIM; IM    
Wistar Institute, Philadelphia, PA 19104.
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MeSH Terms
Base Sequence
Bone Marrow / pathology*
Burkitt Lymphoma / drug therapy,  pathology*
Child, Preschool
DNA, Neoplasm / analysis
Molecular Sequence Data
Polymerase Chain Reaction
Time Factors
Grant Support
Reg. No./Substance:
0/DNA, Neoplasm
Comment In:
N Engl J Med. 1991 Mar 14;324(11):772-5   [PMID:  1997845 ]

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