Monitoring Tumour Cell Purge by Long Term Marrow Culture in Acute Leukemia

Objective: Purging of leukemic cells from bone marrow harvested for autologous bone marrow transplantation (ABMT) remains a challenge. This work aimed at evaluating the efficacy of long-term marrow culture (LTMC) on purging leukemic progenitors in acute leukemia. Design and methods: We planned to study the presence of immunoglobulin heavy (IgH) chain gene rearrangements by polymerase chain reaction (PCR) at diagnosis for bone marrow of 23 patients with acute leukemia. LTMC was performed only for patients who showed positive IgH chain gene monoclonality at diagnosis. The efficiency of purge was evaluated by PCR for monoclonal IgH chain gene on weekly basis of LTMC. Results: Of the 23 studied cases, 18 (78.26%) showed positive clonal IgH chain gene at diagnosis. LTMC study showed that 6/18 (33.33%), 3/18 (16.67%), 7/18 (38.89%) and 2/18 (11.11%) underwent complete purging of the leukemic progenitors at the first, second, third and fourth weeks of culture, respectively. Follow up could be performed for 14 positive ALL cases after induction of remission; 12/14 (85.7%) showed minimal residual disease (MRD) while only two cases did not show MRD. Complete purging of the latter two cases by LTMC occurred on the second and third weeks of culture. Conclusion: LTMC is a useful and successful method for leukemic cell purging. LTMC should be undertaken at initial diagnosis and on an individual basis. Each case should be dealt with solely to determine at which week of culture complete purging could be obtained for subsequent autologous grafting of the purged marrow.