Minimal residual disease in childhood B-lineage lymphoblastic leukemia: persistence of leukemic cells during the first 18 months of treatment
Article Abstract:
Some patients with leukemia may be placed in remission (no detectable level of cancer) following various therapeutic protocols. However, it is unknown whether cancer cells still remain in the body. The present study uses a highly sensitive and sophisticated assay system (polymerase chain reaction) to examine bone marrow cells for the presence of genetically distinct leukemia cells in eight patients in clinical remission from acute lymphoblastic leukemia (ALL), a type of white blood cell cancer involving the lymphocytes. Measurements were made at the time of diagnosis, and at various periods during therapy. A DNA method (Southern Blot) allowed the samples of bone marrow to be tested for the distinctive leukemic cells. Although a reduction of tumor cells occurred (reduced to 1 in 1,000 or 1 in 10,000 cells occurred as a result of treatment), all patients continued to harbor malignant cells up to 18 months after diagnosis. After 18 months, three of four patients no longer had demonstrable tumor cells in marrow samples. Nonetheless, one of these three patients had a relapse, with leukemic cells forming a tumor mass in the brain; another patient had a very large population of bone marrow leukemias cells before a relapse could otherwise be detected. Despite the sensitivity of these tests, relapses can occur in the absence of detectable leukemia cells. A cure in these cases appears to require a complete destruction of all malignant cells, or at least to a level well below the detection level of this method. The ability of this method to predict that a patient may come out of remission before other clinical signs are apparent may indicate that routine surveillance of ALL patients is useful if effective treatment can be developed to keep these patients in remission. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1990
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Silence of the leukemic clone
Article Abstract:
New data suggest that the bone marrow of children in long-term remission from acute lymphoblastic leukemia (ALL) may contain leukemic cells. The development of highly sensitive assays has made detection of low numbers of cells possible. However, the implications are unclear. Research will have to determine whether these are cancerous cells kept in check by the immune system, precancerous cells lacking some other genetic abnormality that triggers cancer, or that the marker gene the assay uses is an innocent gene shared by the cell's formerly cancerous parent line. Meanwhile, patients considered cured should not worry.
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1997
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Clinical significance of minimal residual disease in childhood acute lymphoblastic leukemia
Article Abstract:
Children with acute lymphoblastic leukemia who have residual cancer in their bone marrow after complete remission following chemotherapy have higher risk of relapse. Researchers used the polymerase chain reaction (PCR) to detect residual cancer in the bone marrow of 178 children who were in complete remission following chemotherapy. At all times they were examined during an average follow-up of 38 months, those who had residual cancer were more likely to relapse. Residual cancer was a better predictor of relapse than age and white-cell count at diagnosis.
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1998
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