Mikrochimérismus – na hraně počínajícího relapsu AML?
Authors:
O. Horký; J. Mayer; L. Kablásková; M. Borský; M. Krejčí; D. Dvořáková
Authors‘ workplace:
Centrum molekulární biologie a genové terapie, Interní hematoonkologická klinika LF MU a FN Brno
Published in:
Transfuze Hematol. dnes,15, 2009, No. 2, p. 97-102.
Category:
Comprehensive Reports, Original Papers, Case Reports
Overview
Znovuobjevení či nárůst autologní krvetvorby po alogenní transplantaci hematopoetických buněk bývá spojen s počínajícím relapsem akutní myeloidní leukemie, nicméně význam mikrochimérismu (podílu autologních buněk pod hranicí 1 %) není jednoznačný. Byly porovnávány výsledky fragmentační analýzy (FA) a kvantitativní PCR v reálném čase (RQ-PCR). Hodnoty získané z obou analýz byly konfrontovány s klinickým stavem pacientů: kompletní remise, molekulární relaps, hematologický relaps. Zatímco RQ-PCR analýza periferní krve predikovala hematologický relaps ve 12 případech z 13 (92 %), s mediánem předpovědi 34 dnů (0–322 dní), byla FA úspěšná pouze v pěti případech (38 %) (medián předpovědi 0 dní, 0–154 dní) (p = 0,002). RQ-PCR předcházela FA v 10 případech, s mediánem dřívější předpovědi 35 dní (interval 6–168 dní). RQ-PCR dále zachytila dalších 4 z 6 časných hematologických relapsů (do jednoho roku po transplantaci), mimo dosah senzitivity FA. Kombinace vyšetření periferní krve a kostní dřeně navíc potvrdilo 9 molekulárních relapsů z 9. RQ-PCR se jeví jako citlivá a spolehlivá metoda stanovení mikrochimérismu, jehož dynamika umožňuje zachycení počátku relapsu a umožňuje tak časnou klinickou intervenci.
Klíčová slova:
chimérismus, mikrochimérismus, relaps, AML, RQ-PCR
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Haematology Internal medicine Clinical oncologyArticle was published in
Transfusion and Haematology Today
2009 Issue 2
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