The use of the polymerase chain reaction to predict for subsequent relapse in unrelated marrow transplantation for chronic myelogenous leukemia.

Disease relapse is one of the causes of treatment failure in patients who undergo allogeneic bone marrow transplantation (BMT) for chronic myelogenous leukemia (CML). Emerging data suggest that accepted therapies for patients who relapse such as interferon and donor lymphocyte infusions may be more efficacious and potentially less toxic if given to patients with minimal disease burdens. The effective application of this strategy may therefore be dependent on the early detection of relapse posttransplant using sensitive assays such as the polymerase chain reaction (PCR) for the presence of the bcr/abl transcript. To that end, we have been interested in determining the predictive value of PCR for subsequent relapse in unrelated marrow transplants for CML. In this review, we update our experience in a cohort of 57 patients transplanted with T cell depleted unrelated marrow grafts who were subsequently followed for relapse by PCR.