Molecular quantitation of minimal residual disease in acute myeloid leukemia with t(8;21) can identify patients in durable remission and predict clinical relapse

One of the most common translocations in acute myeloid leukemia (AML) is th e t(8;21), which produces the fusion gene AML1-MTG8. We have developed a se nsitive competitive reverse transcriptase-polymerase chain reaction (RT-PCR ) assay for AML1-MTG8 transcripts, coupled with a competitive RT-PCR for th e ABL transcript as a control to accurately estimate the level of amplifiab le RNA, We have shown that AML1-MTG8 and ABL transcripts have equal degrada tion rates, Thus, this method is useful for multicenter studies. We studied 25 patients with t(8;21) AML by means of serial analysis done on bone marr ow (BM) and peripheral blood (PB) samples from 21 patients. Our analysis sh owed that, in general, a successful induction chemotherapy produces a reduc tion of 2 to 3 log in the level of AML1-MTG8, followed by a further 2 to 3 log after consolidation/intensification chemotherapy, Levels up to 1 x 10(3 ) and 1 x 10(2) molecules/mu g of RNA in BM and PB, respectively, were comp atible with durable remission. On the other hand, 5 patients with levers of 0.71 x 10(5) to 2.27 x 10(5) molecules/mu g of RNA in BM and 2.27 x 10(3) to 2.27 x 10(4) molecules/mu g of RNA in PR had hematologic relapse within 3 to 6 months. Our data indicate that serial quantitation of AML1-MTG8 tran scripts is useful in identifying patients at high risk of relapse and may o ffer an opportunity for clinical intervention to prevent hematologic relaps e, This approach was applied successfully in a patient who had an allogenei c BM transplantation. We also suggest that PB may be used an alternative to BM for quantitating AML1-MTG8 transcripts. (C) 2000 by The American Society of Hematology.