Relapse of acute promyelocytic leukemia follows serial negative RT-PCR assays: a cautionary tale.
Six patients with acute promyelocytic leukaemia (APL) and t(15;17) were investigated by cytogenetics and by reverse transcriptase polymerase chain reaction (RT-PCR) for the fusion transcript PML-RARA. The clone was detected in remission following all-trans retinoic acid and chemotherapy by cytogenetics and/or by RT-PCR up to 2 months from diagnosis. Thereafter the PML-RARA transcript was not seen in 20/21 first remission samples in five cases studied. Remission was maintained in two patients, one following bone marrow transplantation (BMT). Despite serial negative RT-PCR results, PML-RARA reemerged at or prior to relapse following BMT in the remaining three cases. Frequent molecular monitoring and caution in the interpretation of negative RT-PCR results are indicated in APL.
Devaraj
P E
PE
Department of Haematology, Royal Free Hospital, School of Medicine, London, U.K.
Foroni
L
L
Prentice
G H
GH
Hoffbrand
V A
VA
Secker-Walker
L M
LM
D000293:Adolescent; D000328:Adult; D002884:Chromosomes, Human, Pair 15; D002886:Chromosomes, Human, Pair 17; D005260:Female; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012008:Recurrence; D012074:Remission Induction; D012680:Sensitivity and Specificity; D014158:Transcription, Genetic; D014178:Translocation, Genetic