title: The presence of typical and atypical BCR-ABL fusion genes in leukocytes of normal individuals: biologic significance and implications for the assessment of minimal residual disease.
abstract: The number of genetic lesions necessary to generate leukemia in humans is unknown, but it is possible that certain specific abnormalities, eg, fusion genes, known to be associated with acute and chronic leukemia are produced relatively frequently in human cells but require other events to occur before the leukemia becomes manifest. We investigated this possibility by studying peripheral blood leukocytes from normal individuals and various hematopoietic cell lines for the presence and expression of the p210 and the p190 types of the BCR-ABL gene associated with chronic myeloid leukemia (CML) and acute lymphoblastic leukemia. We used two-step reverse transcriptase-polymerase chain reaction (RT-PCR) assays in which batches of 10(8) cells per sample were tested in 40 replicate reactions. We estimate that this assay is 1.5 logs more sensitive than the two-step RT-PCR assays that we use routinely to assess minimal residual disease. BCR-ABL fusion gene transcripts of various configurations were found in circulating leukocytes from 12 of the 16 healthy adults analyzed. Transcripts with an e1a2 junction (p190 BCR-ABL) were present in 11 and p210-type transcripts with b2a2 and/or b3a2 junctions were detected in 4 individuals. The same RT-PCR assays in non-CML cell lines showed the presence of classical or aberrant p210-type mRNA in 3 of 7 lines and of p190-type transcripts in all 7 lines of hematopoietic origin (HL60, KG1, U937, Kasumi, Jurkat, JVM13, and JVM25), whereas the NIH3T3 murine fibroblast line was reproducibly negative for these fusion genes. These findings confirm and extend previous reports on the detection of leukemia-associated genes in normal leukocytes and suggest that certain fusion genes are generated relatively frequently in hematopoietic cells, but only infrequently do the cells acquire the additional changes necessary to produce leukemia in humans. Although there is only a small probability that such innocent BCR-ABL-carrying leukocytes are detected by conventional RT-PCR assays, they may be the source of some sporadically positive tests in leukemia patients in long-term remission.
authors.affiliation: LRF Centre for Adult Leukaemia, Department of Haematology, Imperial College School of Medicine, Hammersmith Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Bose
authors.forename: M
authors.initials: M
authors.lastname: Deininger
authors.forename: J
authors.initials: J
authors.lastname: Gora-Tybor
authors.forename: J M
authors.initials: JM
authors.lastname: Goldman
authors.forename: J V
authors.initials: JV
authors.lastname: Melo
mesh_terms: D016475:3T3 Cells; D000328:Adult; D000818:Animals; D018076:DNA, Complementary / Q000235:genetics; D005189:False Positive Reactions; D005260:Female; D016044:Fusion Proteins, bcr-abl / Q000235:genetics*; D016313:Genes, abl; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000175:diagnosis / Q000235:genetics / Q000473:pathology*; D007962:Leukocytes / Q000737:chemistry*; D008297:Male; D051379:Mice; D018365:Neoplasm, Residual; D009857:Oncogenes; D012333:RNA, Messenger / Q000097:blood; D012016:Reference Values; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014407:Tumor Cells, Cultured
chemical_list: D018076:DNA, Complementary; D012333:RNA, Messenger; D016044:Fusion Proteins, bcr-abl