[Significance of clonal TCR gene rearrangement in acquired pure red cell aplastic anemia].
OBJECTIVE
To evaluate the significance of T-cell antigen receptor (TCR) gene rearrangement among patients with acquired pure red cell aplastic anemia (A-PRCA).


METHODS
For 16 patients with A-PRCA, an immunosuppressive regimen based on cyclosporin A (CsA) was applied. Rearrangement of the TCR gene was detected by PCR, and T lymphocyte subsets in peripheral blood specimens was detected with flow cytometry.


RESULTS
Five patients had presented with TCR clonal rearrangement and were positive for both TCR γ and TCR δ. The blood of 13 patients have returned to normal with the treatment, which included 3 cases with bone marrow returning to normal. In 7 cases, the red cell hyperplasia of bone marrow is still down, but has increased with the treatment. Three patients were close to cure, 7 showed remission, 3 were improved, but 3 were ineffective. The rate of effective treatment in those with TCR rearrangement (2/5) was significantly lower than that those without (11/11, chi-square=8.123, P < 0.05). Compared with those without the TCR gene rearrangement, the Th cells and proportion of Th/Ts were significantly lower, while the Ts cell (CD3+CD8+) were significantly higher in those with the rearrangement (P < 0.05).


CONCLUSIONS
TCR gene rearrangement may play a role in the pathogenesis of A-PRCA. CsA is effective for the treatment of A-PRCA, but patients presenting clonal TCR gene rearrangement may response poorly to the treatment.
Department of Hematology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumuqi, Xinjiang 830020, China. wangxiaoming@medmail.com.
Zengsheng
Z
Wang
Li
L
An
Tabaier
T
Muhe
Xiaoyan
X
Zhang
Ling
L
Fu
Xiaomin
X
Wang
D000328:Adult; D000368:Aged; D005260:Female; D015329:Gene Rearrangement, T-Lymphocyte; D006801:Humans; D008297:Male; D008875:Middle Aged; D012010:Red-Cell Aplasia, Pure / Q000209:etiology / Q000235:genetics* / Q000276:immunology