Table 6.5 Clinical utility of PCR-based studies in patients with leukemia and lymphoma.
• Detection of bone marrow infiltration as part of staging procedure.
• Detection of circulating lymphoma cells in peripheral blood.
• Detection of minimal residual disease following therapy.
• Assessing contribution of reinfused lymphoma cells to relapse in patients undergoing autologous bone marrow transplantation.
• Assessing ability of purging techniques to eradicate residual malignant cells in marrow.
The standard technique used for the diagnosis of NHL is light microscopy of stained sections of lymph node or other tissue. This allows accurate classification of lymphoma subtype. In terms of detecting MRD, this technique has the limitation of detecting lymphoma cells only when they constitute approximately 5% or more of all cells (i.e. one malignant cell in 20 normal cells). Application of flow cytometric analysis for the detection of NHL has been hampered by the lack of lymphoma-specific monoclonal antibodies since all the cell surface antigens identified to date on the surface of lymphoma cells are also present on normal B cells or B-cell precursor cells (Table 6.5).
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