title: Molecular analysis of the CDR3 encoding region of the immunoglobulin heavy chain locus in cerebrospinal fluid cells as a diagnostic tool in lymphomatous meningitis.
abstract: The diagnosis of leptomeningeal B-cell lymphoma is based on the identification of malignant B cells in the cerebrospinal fluid (CSF). Frequently, cytology does not allow clear distinction between neoplastic lymphoid cells and reactively transformed mononuclear cells. Individual B-cell clones can be identified on the basis of DNA sequences that encode the highly diverse complementarity-determining region (CDR3) of the immunoglobulin heavy chain locus (IgH). We studied CSF samples from 5 patients with B-cell malignancies and cytological evidence of leptomeningeal involvement, using polymerase chain reaction (PCR)-based high-resolution capillary electrophoresis and automated fluorescence analysis to detect PCR fragments. As controls, we assessed CSF specimens from 7 patients with inflammatory neurological diseases and three samples without pathological findings. In all patients with B-cell malignancies, a single PCR product was generated, indicating that CDR3-specific fragments were derived from monoclonal cell populations. CSF samples from patients with inflammatory diseases yielded multiple CDR3 amplicons, suggesting the presence of a polyclonal B-cell activation. No PCR product could be amplified in normal CSF samples. Automated fluorescence detection of CDR3 fragments is a highly sensitive and rapid method to distinguish neoplastic monoclonal and reactive polyclonal B-cell populations in the CSF.
authors.affiliation: Department of Neurology, University of Heidelberg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Storch-Hagenlocher
authors.forename: J
authors.initials: J
authors.lastname: Haas
authors.forename: M E
authors.initials: ME
authors.lastname: Vogt-Schaden
authors.forename: M
authors.initials: M
authors.lastname: Bentz
authors.forename: L A
authors.initials: LA
authors.lastname: Hoffmann
authors.forename: A
authors.initials: A
authors.lastname: Biessmann
authors.forename: B
authors.initials: B
authors.lastname: Wildemann
mesh_terms: D001483:Base Sequence / Q000235:genetics; D002555:Cerebrospinal Fluid / Q000166:cytology / Q000502:physiology*; D002874:Chromosome Mapping; D022801:Complementarity Determining Regions; D019075:Electrophoresis, Capillary; D005453:Fluorescence; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics*; D007135:Immunoglobulin Variable Region / Q000235:genetics*; D016393:Lymphoma, B-Cell / Q000150:complications*; D008582:Meningitis, Aseptic / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000209:etiology*; D016133:Polymerase Chain Reaction
chemical_list: D022801:Complementarity Determining Regions; D007143:Immunoglobulin Heavy Chains; D007135:Immunoglobulin Variable Region