title: Quantitative PCR of bone marrow BCL2/IgH+ cells at diagnosis predicts treatment response and long-term outcome in follicular non-Hodgkin lymphoma.
abstract: By real-time quantitative polymerase chain reaction (RQ-PCR), we evaluated BCL2/IgH(+) cells in the bone marrow (BM) and peripheral blood (PB) from 86 patients with follicular lymphoma treated with the sequential administration of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) and rituximab. At diagnosis, the amount of BCL2/IgH(+) cells in the BM was low (1 BCL2/IgH(+) cell in 1000-100 000 normal cells) in 43% of patients, intermediate (1 in 100-1000) in 34%, and high (> 1 in 100) in 23%. A 2 log decrease of BCL2/IgH(+) cells was achieved after CHOP and an additional 2 log reduction following rituximab. By multivariate analysis, a low level of BCL2/IgH(+) cells in the BM at diagnosis was the best predictor for the achievement of a complete clinical and molecular response. At 5 years, the event-free survival rates of patients with a low/intermediate or high tumor infiltration in the BM were 59% and 32%, respectively. The freedom from recurrence of patients who achieved a molecular response in the BM, no matter whether after CHOP alone or CHOP and rituximab, was 64% as compared to 32% for patients who did not (P < .006). RQ-PCR performed at presentation on BM samples predicts treatment response and long-term clinical outcome in patients with follicular lymphoma.
authors.affiliation: Divisione di Ematologia, Ospedali Riuniti Largo Barozzi 1, 24100, Bergamo, Italy. arambaldi@ospedaliriuniti.bergamo.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rambaldi
authors.forename: Emanuela
authors.initials: E
authors.lastname: Carlotti
authors.forename: Elena
authors.initials: E
authors.lastname: Oldani
authors.forename: Irene
authors.initials: I
authors.lastname: Della Starza
authors.forename: Michele
authors.initials: M
authors.lastname: Baccarani
authors.forename: Sergio
authors.initials: S
authors.lastname: Cortelazzo
authors.forename: Francesco
authors.initials: F
authors.lastname: Lauria
authors.forename: Luca
authors.initials: L
authors.lastname: Arcaini
authors.forename: Enrica
authors.initials: E
authors.lastname: Morra
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pulsoni
authors.forename: Luigi
authors.initials: L
authors.lastname: Rigacci
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rupolo
authors.forename: Francesco
authors.initials: F
authors.lastname: Zaja
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Zinzani
authors.forename: Tiziano
authors.initials: T
authors.lastname: Barbui
authors.forename: Robert
authors.initials: R
authors.lastname: Foa
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001854:Bone Marrow Cells / Q000473:pathology*; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000032:analysis*; D008224:Lymphoma, Follicular / Q000235:genetics / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D011239:Prednisolone / Q000008:administration & dosage; D011379:Prognosis; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000032:analysis*; D000069283:Rituximab; D016019:Survival Analysis; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007143:Immunoglobulin Heavy Chains; D019253:Proto-Oncogene Proteins c-bcl-2; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone