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  • 1
    Online Resource
    Online Resource
    Wiley ; 2002
    In:  Cell Biochemistry and Function Vol. 20, No. 3 ( 2002-09), p. 191-194
    In: Cell Biochemistry and Function, Wiley, Vol. 20, No. 3 ( 2002-09), p. 191-194
    Type of Medium: Online Resource
    ISSN: 0263-6484 , 1099-0844
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2002
    detail.hit.zdb_id: 1496553-7
    SSG: 12
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  • 2
    In: Biology of Blood and Marrow Transplantation, Elsevier BV, Vol. 12, No. 12 ( 2006-12), p. 1270-1276
    Type of Medium: Online Resource
    ISSN: 1083-8791
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2006
    detail.hit.zdb_id: 3056525-X
    detail.hit.zdb_id: 2057605-5
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  • 3
    In: Experimental Hematology, Elsevier BV, Vol. 34, No. 12 ( 2006-12), p. 1680-1686
    Type of Medium: Online Resource
    ISSN: 0301-472X
    RVK:
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2006
    detail.hit.zdb_id: 2005403-8
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  • 4
    In: Blood, American Society of Hematology, Vol. 114, No. 22 ( 2009-11-20), p. 960-960
    Abstract: Abstract 960 Background and aims: We have recently shown that multiple myeloma (MM) patients undergoing autologous transplantation (ASCT) followed by a consolidation with Bortezomib/Thalidomide/Dexamethasone (VTD) achieve molecular remission in 17% and major tumor shrinking assessed by real time-quantitative (RQ) PCR in the majority of cases (Ladetto et al, ASH Meeting 2008). However little is known on the minimal residual disease (MRD) kinetics occurring after such an extensive cytoreduction. In this study we have investigated the disease kinetics in the post-consolidation phase with the aim of identifying the RQ-PCR patterns associated with persistent remission or increased risk of relapse. Patients and methods: Inclusion criteria and consolidation treatment for this study have been already reported and included: 1) a documented complete or very good partial remission following ASCT delivered as first line treatment; 2) no previous treatment with thalidomide and bortezomib; 3) presence of a molecular marker based on the immunoglobulin heavy chain rearrangement (IgH-R). Consolidation consisted of four courses of: a) Bortezomib 1.6 mg/m2 on days 1, 8, 15, 22; b) Thalidomide at the initial dose of 50 mg/day with increments up to 200 mg; c) Dexamethasone 20 mg/day on days 1 to 4, 8 to 11 and 15 to 18. MRD was assessed on bone marrow samples at diagnosis, study entry, after two VTD courses, at the end of treatment and then at six months intervals. Qualitative and RQ-PCR analysis were carried out using IgH-R derived patient specific primers as already described (Voena et al, Leukemia 1997; Ladetto et al, Biol Bone Marrow Transpl 2000). MRD kinetics of relapsing vs non relapsing patients has been measured using observed marginal medians of ln RQ-PCR values. For the predictive value of MRD kinetics patients were defined as having low tumor burden (TB) if they reached after VTD a MRD level 〈 100 IgH-R/106 diploid genomes and as having active disease whenever a 10-fold tumor burden increase was recorded. Results: Feasibility, toxicity and clinical outcome of the trial have been already reported (Ladetto et al, ASH Meeting 2008). Thirty-nine patients were enrolled. Median follow-up from study entry is currently 32 months (50 from start of first line treatment). Following VTD, six patients achieved molecular remission (MR). Of these none has so far experienced a clinical relapse. MR was persistent in all patients, with an occasional PCR positive result in a patient who later reverted to PCR negativity. Among PCR positive patients 12 clinical relapses have been so far reported (50 months PFS: MR 100% vs no MR 62% - Figure 1A, p 〈 0.001). Figure 2 shows the kinetics of MRD overtime in relapsing vs not relapsing patients (p 〈 0.001), assessed on 230 RQ-PCR determinations at different timepoints. When RQ-PCR results of PCR positive patients were correlated with outcome we observed the following: 1) 14 patients achieved low TB and never had signs of active disease: none of them has so far relapsed except one who refused to undergo MRD monitoring and relapsed three year after the last PCR evaluation; 2) 13 patients never achieved a low TB and 8 of them relapsed; 3) 5 patients achieved a low TB but subsequently showed evidence of active disease: 3 of them relapsed. Patients in the first subgroup showed a 50 months PFS of 100% as opposed to those in group 2-3 who had a PFS of 37% (Figure 1B, p=0.001). Conclusions: Our results indicate that: 1) MRs following VTD are stable over time with no evidence of clinical and molecular relapse; 2) The vast majority of relapses occur in patients failing to achieve a low and stable TB; 3) Molecular monitoring of MRD allows to identify a large subset of patients (51% of cases) with an extremely low-risk of short-term relapse. Disclosures: Ladetto: CELGENE: Honoraria; JANSSEN-CILAG: Research Funding. Cavallo:CELGENE: Honoraria. Caravita:CELGENE: CONSULTANCY. Musto:JANSSEN-CILAG: Honoraria; CELGENE: Honoraria. Boccadoro:CELGENE: CONSULTANCY, ADIVISORY COMMITTEES, Research Funding; JANSSEN-CILAG: CONSULTANCY, ADIVISORY COMMITTEES, Research Funding; PHARMION: CONSULTANCY, ADIVISORY COMMITTEES, Research Funding. Palumbo:CELGENE: Honoraria; JANSSEN-CILAG: Honoraria.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2009
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    detail.hit.zdb_id: 80069-7
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  • 5
    In: Blood, American Society of Hematology, Vol. 103, No. 12 ( 2004-06-15), p. 4644-4649
    Abstract: In this study we investigated telomere restriction fragment (TRF) length in a panel of mature B-cell lymphoproliferative disorders (MBCLDs) and correlated this parameter with histology and histopathogenesis in relation to the germinal center (GC). We assessed 123 MBCLD samples containing 80% or more tumor cells. TRF length was evaluated by Southern blot analysis using a chemiluminescence-based assay. GC status was assessed through screening for stable and ongoing somatic mutations within the immunoglobulin heavy-chain genes. Median TRF length was 6170 bp (range, 1896-11 200 bp) and did not correlate with patient age or sex. TRF length was greater in diffuse large cell lymphoma, Burkitt lymphoma, and follicular lymphoma (medians: 7789 bp, 9471 bp, and 7383 bp, respectively) than in mantle cell lymphoma and chronic lymphocytic leukemia (medians: 3582 bp and 4346 bp, respectively). GC-derived MBCLDs had the longest telomeres, whereas those arising from GC-inexperienced cells had the shortest (P & lt; 10-9). We conclude that (1) TRF length in MBCLD is highly heterogeneous; (2) GC-derived tumors have long telomeres, suggesting that minimal telomere erosion occurs during GC-derived lymphomagenesis; and (3) the short TRF lengths of GC-inexperienced MBCLDs indicates that these neoplasms are good candidates for treatment with telomerase inhibitors, a class of molecules currently the subject of extensive preclinical evaluation. (Blood. 2004;103:4644-4649)
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2004
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 6
    In: Blood, American Society of Hematology, Vol. 112, No. 11 ( 2008-11-16), p. 3683-3683
    Abstract: Background and aims. In multiple myeloma (MM) molecular remission (MR) is usually not achieved with autologous transplantation (ASCT) as opposed to allogeneic transplantation where it occurs frequently and associates to an improved outcome. Aim of this study was to assess, by qualitative and quantitative PCR, the impact of a consolidation treatment, including Bortezomib/Thalidomide/Dexamethasone (VTD) on residual MM cells in patients achieving a good clinical response after ASCT. Patients and methods: Inclusion criteria were: a documented complete or very good partial remission (CR or VGPR) following ASCT delivered as first line treatment; no previous treatment with thalidomide and bortezomib; presence of a molecular marker based on the immunoglobulin heavy chain rearrangement (IgH-R). VTD had to be started within 6 months from ASCT. Each cycle consisted of: Bortezomib 1.6 mg/m2 as an IV injection once weekly (on days 1, 8, 15, 22) followed by a 13-day rest period (days 23–35); Thalidomide at the initial dose of 50 mg/day PO once daily, with increments of 50 mg every 7 days up to 200 mg; Dexamethasone 20 mg/day PO once daily, on days 1 to 4, 8 to 11 and 15 to 18 followed by a 17-day rest period (days 19–35). A total of 4 cycles were delivered. MRD was assessed on bone marrow (BM) samples at diagnosis, study entry, after two VTD courses, at the end of treatment and then at six months intervals. Qualitative and quantitative PCR analysis were carried out using IgH-R-derived patient-specific primers as already described (Voena et al, Leukemia 1997; Ladetto et al, Biol Bone Marrow Transpl 2000). Results: Forty pts were enrolled and are evaluable at study entry. 20% of patients did not receive the whole planned treatment, but were nevertheless included in MRD analysis. Median follow-up from study entry is currently 21 months. Qualitative PCR has been performed on the whole population (overall 198 samples). Six patients converted to MR (defined as two consecutive PCR-negative samples, spaced at least three months) while two patients had an isolated PCR-negative result. Patients in MR persisted in their status with the exception of one molecular relapse at 24 months. No clinical relapse has been so far observed in MR patients at a median follow-up of 26 months (18–30). Among patients not achieving MR we observed eight relapses occurring at a median time of 12 months (4–26). Quantitative PCR has been performed on 20 patients (overall 105 samples). Median tumor bulk at diagnosis was 157000 (35-925000) IgH-R/106 diploid genomes (dg). It shrunk to 440 (3-420000) following ASCT and to 17 (0-113000) following VTD. The effect of VTD was detectable both in patients in VGPR and CR. Follow-up analysis by real time PCR at six, 12 and 18 months in persistently PCR-positive patients revealed stable MRD levels in 66% of patients and a growth greater than one log in 33%. Notably, patients who already relapsed were characterized by a tumor load persistently greater than 100 IgH-R/106dg except one who showed a transient tumor cell reduction after 2 VTD courses followed by a sharp increase in his MRD level. Conclusions: Post-transplant VTD consolidation is active on residual plasma cells surviving ASCT. Moreover a proportion of CR/VGPR MM enters MR which might persist up to 30 months. Thus, new non-chemotherapeutic agents can substantially improve the quality of remission in MM patients even in case of optimal response to ASCT.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2008
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 7
    In: Blood, American Society of Hematology, Vol. 114, No. 22 ( 2009-11-20), p. 2808-2808
    Abstract: Abstract 2808 Poster Board II-784 Background and aims: Characterization of the IgH receptor provides useful insights to understand the pathogenesis and natural history of lymphoid tumors. For example the recognition of stereotyped clusters of immunoglobulin receptors has been a major step forward to understand the pathogenesis of chronic lymphocytic leukemia (CLL). IgH rearrangements have been less extensively investigated in MM, mostly because of lack of large databases of IgH sequences. At our Institution a large number of MM patients has undergone IgH sequencing for minimal residual disease (MRD) evaluation. This database has been merged with MM IgH sequences available in the literature, resulting in 308 MM sequences which have been employed to comprehensively investigate the characteristics of the IgH rearrangement in this tumor. Patients and methods: 131 IgH genes from MM patients were amplified and direct sequenced at our Institution (mostly for MRD detection purposes) from specific cDNA obtained at diagnosis, as already described (Voena et al, Leukemia 1997). 177 MM IgH sequences were derived from published databases (NCBI and EMBL). To further characterize the IgH repertoire, we have then compared the MM complementarity-determining region 3 (HCDR3) amino acid (AA) sequences to a panel of productive, non redundant 27413 HCDR3 AA sequences retrieved from public databases (EMBL, NCBI, IMGT/LIGM-DB: 25655 sequences) and from our unpublished laboratory database (1758 sequences), including sequences from malignant B-cell clones (3197 CLL, 1217 lymphomas) and from non malignant repertoire (2685 autoreactive, 4408 immunederegulation/immunodeficiency, 15429 normal and 477 phage display libraries). All the sequences have been analyzed using the IMGT database and tools (Lefranc et al., Nucleic Acid Res. 2005; http://imgt.cines.fr/) to identify IGHV, IGHD and IGHJ gene usage, to assess the somatic hypermutation (SHM) rate and to identify HCDR3 AA sequences. HCDR3 AA sequences were aligned together, in search of subsets of stereotyped receptors, using the ClustalX 2.0 software (http://www.clustal.org/). To define subsets of stereotyped IgH receptors, we followed the criteria proposed by Messmer et al. (J Exp Med. 2004) and Stamatopoulos et al. (Blood, 2007). Results: No significant differences were noted between our Institutional and published MM databases. Overall IGHV usage in MM appeared in keeping with the normal B cell repertoire with predominance of IGHV3 family (53.9%) followed by IGHV4 (slightly under-represented in MM, 17.2% vs 23.2%, p=0.02) and IGHV1 (12%); besides an over-representation of IGHV2 (7.8% vs 2.3%, p 〈 0.001) was noticed. A modest but significant (p 〈 0.05) over-representation of the IGHV3-9 (5.2% vs 2.6%), IGHV3-21 (4.5% vs 2%), IGHV5-51 (4.5% vs 2.2%) genes and under-representation of the IGHV3-23 (8.1% vs 12.2%) and IGHV4-34 (1% vs 6.5%, p 〈 0.001) were observed. IGHD and IGHJ followed a distribution similar to that of normal IgH repertoire. The median SHM rate was 7.5% (range 0-28%): interestingly we found one single patient with 100% identity to the germline sequence and only three patients with 〉 98% identity. The median length of the HCDR3 was 15 AA (range 7-29), again in line with normal IgH repertoire. Intra MM search for HCDR3 similarity showed no association which met minimal requirements to define stereotyped receptors. The comparison of MM sequences with non MM database showed that 98% of MM sequences are unrelated to known CLL subsets. Among the remaining, 3 MM sequences could be assigned to previously identified CLL subsets (namely n. 25, n. 37 and n. 71 according to Murray et al., Blood 2008) whereas 2 MM formed 2 novel provisional subsets with CLL. When HCDR3 MM were compared to the database of non MM/CLL HCDR3, similarities were found with clones from normal B cells, while similarities with autoreactive clones and other B cell malignancies were sporadic. Conclusions: The analysis of the largest database of MM IgH sequences so far reported indicate the following: 1) Family usage in the MM IgH repertoire follows a nearly physiological distribution apart for modest skewing of a number of IGHV genes; 2) MM specific HCDR3 clusters do not occur to a frequency detectable with currently available databases; 3) The vast majority of MM sequences are not related to known CLL clusters; 4) MM IgH sequences share more similarities with normal IgH sequences compared to those derived from pathological B lymphoid cells. Thus to state of current knowledge there is little evidence in favor of an antigen driven pathogenesis for this neoplasm. Disclosures: No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2009
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 8
    In: Blood, American Society of Hematology, Vol. 106, No. 11 ( 2005-11-16), p. 5088-5088
    Abstract: Introduction: array-CGH is significantly impacting on cancer cytogenetic. We used this technique to perform pan-genomic screening in 15 patients with MM and 4 with de novo PCL. Patients and methods. Bone marrow samples were employed. If tumor contamination was below 20% plasma cells were purified with Myltenyi columns. Array-CGH was performed as follows: genomic DNAs, from both the tumor and normal reference cells, labeled with different fluorescent dyes were cohybridized to 1 Mb resolution arrays containing 2600 Bacteria Artificial Chromosome (BAC) clones (Spectral Genomics Inc, Houston, TX, USA) according to manufacturer’s recommendations. Variations in DNA sequence copy number for each BAC clone was assessed by relative fluorescence signal intensities, in a single hybridization, providing a locus-by-locus measure of DNA copy-number changes. Results: The assay was validated as follows: three normal DNAs were tested revealing no genetic imbalances. One normal male was tested against one normal female and sex chromosome (ch) imbalances were effectively detected. Array-CGH results for ch 13q14.3 deletions were matched with FISH results and concordance was seen in 87% of cases. The median number of lesions/patient observed in our panel was 17 (4–135) (fig 1a). Also the amount of the total genome affected by chromosomal imbalances was highly variable (median 3.9% range: 0.14%–27%) (fig 1a). The amount of involved genome did not correlate with the actual number of lesions (fig 1a). A good correlation was noticed between the amount of losses and gains in each patient (fig1b). Notably PCL do not have a more disrupted genome compared to MM patients as one might expects based on the highly malignant behavior (fig 1a). Interestingly two patients with a prolonged clinical history of MGUS prior to MM diagnosis had massive presence of losses ad gains. Of 2600 BACs 934 were never affected, 864 were targeted only in one patient (pt), 401 in two pts, 296 in 3–5 pts and only 105 were targeted in six pts or more (fig 1c). These 105 recurrent imbalances could be attributed to 9 different abnormalities. Among these we have identified five recurrent lesions (occurring in at least six patients) that have not been previously described. These are 19p13.2 (gain 9 pts, loss 1 pt), 14q12 (loss 3 pts, gain 4 pts), 16q12.1 (loss 6 pts) 11q24 (gain 6 pts), 9q23 (gain 6 pts). Conclusions: array-CGH allow effective pan-genomic screening of MM patients; the pattern of genetic disruption is highly heterogeneous with a majority of non-recurrent or uncommonly recurrent lesions; a number of highly recurrent lesions have been identified that will require assesment for prognostic impact; the overall amount of perturbed genome does not seem to correlate with more aggressive disease, and might be the reflection of alternative biologic features (f.e. a prolonged history of clonal disease). Figure Figure
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2005
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 9
    In: Blood, American Society of Hematology, Vol. 110, No. 11 ( 2007-11-16), p. 530-530
    Abstract: Background and aims: Persistence of molecularly detectable minimal residual disease (MRD) is a nearly constant finding in MM following autologous transplantation (ASCT). On the other hand, molecular remission (MR) can be obtained in MM in the allogeneic setting and is a basic requisite for long-term disease control (Corradini et al, Blood 2003). In this study a consolidation treatment, including Bortezomib/Thalidomide/Dexamethasone (VTD), was employed in the post-ASCT setting in patients (pts) undergoing strict molecular monitoring by qualitative and quantitative PCR to induce further cytoreduction and to verify if a proportion of them could enter MR. Patients and methods: Inclusion criteria were: a documented complete or very good partial remission (CR or VGPR) following ASCT delivered as first line treatment; no previous treatment with thalidomide and bortezomib; presence of a molecular marker based on the IgH rearrangment. Primary endpoint of the study was to obtain MR in 〉 20% of pts. Methods: VTD had to be started within 6 months from ASCT. Each cycle consisted of: Bortezomib 1.6 mg/m2 as an IV injection once weekly (on days 1, 8, 15, 22) followed by a 13-day rest period (days 23–35); Thalidomide at the initial dose of 50 mg/day PO once daily, with increments of 50 mg every 7 days up to 200 mg; Dexamethasone 20 mg/day PO once daily, on days 1 to 4, 8 to 11 and 15 to 18 followed by a 17-day rest period (days 19–35). A total of 4 cycles were delivered. MRD was assessed on bone marrow (BM) samples at study entry, after two VTD courses, at the end of treatment and then at six months intervals. Qualitative and quantitative PCR analysis were carried out using IgH-derived patient-specific primers as already described (Voena et al, Leukemia 1997; Ladetto et al, Biol Bone Marrow Transpl 2000). Results: Forty pts were enrolled and are evaluable at study entry. As expected 94% of pts were PCR-positive following ASCT. 18% did not receive the whole planned treatment, including one toxic death. The six pts requiring treatment reduction/discontinuation were nevertheless included in the MRD analysis. 35 PCR-positive pts at study entry are evaluable after 2 VTD courses and 17% converted to PCR negativity. 27 pts are evaluable at the end of the program with a PCR-negativity rate of 22%. Subsequent follow-up samples are available in 22 pts. All PCR-negative pts assessed at 6 months (four cases) and at 6 and 12 months (two cases) persisted in MR. Seven relapses/progressions occurred and were all among PCR-positive pts. Real-time PCR has been so far performed in ten persistently PCR-positive pts with a 〉 0.5 log tumor reduction in eight of them (median 1.2 log; range 0.2–2.1). Conclusions: VTD consolidation allows a proportion of CR/VGPR MM pts to enter MR and has a measurable anti-tumor effect also in persistently PCR-positive pts. This study is the first demonstration that new non chemotherapeutic agents have activity on MRD persisting following ASCT and indicate that MR is an achievable goal also outside the allogeneic transplantation setting.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2007
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 10
    In: Blood, American Society of Hematology, Vol. 104, No. 11 ( 2004-11-16), p. 1373-1373
    Abstract: Introduction: NLABRs are frequently observed in cancer free-subjects. We recently observed that NLABR-positive clones can persist up to 60 days (Ladetto et al, J Clin Oncol 2003). However the long-term kinetics and potential pre-neoplastic role of NLABR-carrying cells are unknown. To define the natural history of NLABR-positive clones, long term monitoring of cancer-free subjects carrying these lesions has been performed. Methods: 118 subjects undergoing periodical blood examinations for warfarin therapy were screened for the bcl-2/IgH translocation. PCR-positive subjects underwent subsequent monitoring at least once every three months. NLABR-positive clones were monitored using both nested and real time-PCR according to previously published approaches (Ladetto et al Exp Hematol 2001). Sequence homology of NLABRs has always been confirmed by direct sequencing of nested PCR products. Results: 15 NLABR-positive subjects were identified out of 118 (12.7%) subjects. NLABR-positive subjects were monitored for a median time of 13 months (mos) (range 3–30 mos) for a total number of 60 timepoints. In eight subjects (53%), NLABRs detected at study initiation were not detected again in follow-up samples. These eight subjects have been monitored for median period of 12 mos (range 3–28 mos). Follow-up samples in this group were usually PCR-negative, although transient PCR-positivity due to unrelated NLABRs were noticed in two samples. In seven subjects (47%), the same NLABR observed at study initiation was detected one or more times at follow-up. In four subjects, NLABRs detected at diagnosis were amplified in every available follow-up sample (three to seven samples were available for each subject). In three, NLABRs detected at diagnosis were amplified only in a fraction of follow-up samples while the remaining were PCR-negative. Overall, persistent NLABRs were followed on these subjects for a median time of 15 months (range 3–30). The median burden of persistent NLABRs assessed by real-time PCR was 33 rearrangements (rg)/106 diploid genomes (dg) (range 〈 10–760), while the median burden of short-lived NLABRs was 〈 10rg/106 dg (range 〈 10–330). The number of NLABR-positive cells appeared to be rather stable in subjects with persistent NLABR-positive clones. In none of these subjects we could detect differences greater than 1 log among available follow-up samples. Subjects having mixed PCR-positive and PCR-negative results had a smaller tumor burden compared to those constantly PCR-positive. This is consistent with the presence of a small though persistent clonal population. Studies on selected populations showed that NLABR-positive cells were CD19-positive. Discussion: NLABR-positive clones are long-lived cell populations in approximately 50% of cases. Based on this finding it is reasonable to hypothesize the existence of a follicular lymphoma (FL)-related lymphoproliferation of undetermined significance. Since NLABRs occurs in more than than 10% of healthy subjects, this condition is expected to be highly prevalent in the general population (as observed in MGUS and CLUS) and of potential relevance for the pathogenesis of FL.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2004
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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