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Minimal residual disease (MRD) detection using rearrangement of immunoglobulin/T cell receptor genes in adult patients with acute lymphoblastic leukemia (ALL)

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Abstract

MRD detection with allele-specific oligonucleotide-quantitative polymerase chain reaction (ASO-qPCR) and using clone-specific immunoglobulin/T cell receptor rearrangements is considered as a powerful prognostic factor in acute lymphoblastic leukemia (ALL). In the present study, we evaluated an ASO-qPCR assay for MRD quantification in peripheral blood (PB) samples of adult patients with ALL. DNA was isolated from PB samples of patients with newly diagnosed ALL. They were first investigated by multiplex-PCR assay to identify V/J usage. An ASO-qPCR technique was then applied for 2.5-year monthly MRD quantification for detection of patient-specific Ig/TCR receptor rearrangements as a molecular target. From 98 patients who were diagnosed as ALL, 72 (73.5%) were enrolled in the present study for MRD detection. MRD was successfully quantified in patients with 1-month interval time. MRD level at the end of induction therapy up to day 88 was the only significant prognostic factor. Regarding MRD level, patients were categorized into two groups of low and high-risk. 2.5-year OS in all three time points (days 28, 58 and 88) were significantly lower in high-risk group (P < 0.008). The results of the 2.5-year MRD detection indicate that MRD level at the end of induction up to about 6 months after the first diagnosis was associated with clinical outcome. This study may highlight the usefulness of PB and the definitions of cut-off level for early prediction of relapse and for stratifying ALL patients. Short-interval time points and frequent PB sampling to monitor MRD level is suggested for early clinical relapse prediction and clinical management of the disease.

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Funding

This study was supported by Hematologic Malignancies Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. (Grant numbers: 25849-36-01-93 and 25934-36-02-93).

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Authors and Affiliations

  1. Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

    Sepideh Shahkarami & Javad Tavakkoly-Bazzaz

  2. Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Sepideh Shahkarami, Roya Mehrasa, Samareh Younesian, Marjan Yaghmaie, Bahram Chahardouli, Mohammad Vaezi, Mohsen Nikbakht, Kamran Alimoghaddam, Ardeshir Ghavamzadeh & Seyed H. Ghaffari

  3. Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran

    Nima Rezaei

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  1. Sepideh Shahkarami
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  2. Roya Mehrasa
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  3. Samareh Younesian
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  11. Javad Tavakkoly-Bazzaz
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Correspondence to Javad Tavakkoly-Bazzaz or Seyed H. Ghaffari.

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This study was carried out according to the Helsinki declaration. The Regional Ethics Committee of Tehran University of Medical Sciences approved the study. Informed consent was obtained from all patients included in the study.

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Shahkarami, S., Mehrasa, R., Younesian, S. et al. Minimal residual disease (MRD) detection using rearrangement of immunoglobulin/T cell receptor genes in adult patients with acute lymphoblastic leukemia (ALL). Ann Hematol 97, 585–595 (2018). https://doi.org/10.1007/s00277-018-3230-z

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