克隆性基因重重排在淋巴瘤诊断中的应用.pptVIP

(5）比较两个淋巴瘤克隆性的相关性，或区别复发和第二原发肿瘤。组织细胞/树突细胞肉瘤-ALL,T淋母(6）外周血和骨髓累及情况胃DLBCL外周血胃DLBCL，要求观察外周血累及情况MRD理想的检测方法：活检组织的PCR产物克隆，对连接区进行测序，再设计病人特异的引物做real-PCR进行MRD的评价应用策略采用所有引物组，工作量大，不实用，没有必要，有交叉和重叠合理的应用策略——以最少的引物组最大可能地检测克隆性SuspectedB-cellProliferationsSuspectedLymphoidProliferationsofunknownorigin(BorT)SuspectedT-cellProliferationsTCRγδ+ProliferationsorimmatureT-cellIGH(VH-JH)IGKPreferablywithNoclonalitybutstillsuspectedIGH(DH-JH)PreferablywithIGLClonal(generallymultiipleClonalresults)ClonalNoevidenceofclonalityTCRBPreferablywithTCRGTCRGTCRDandResultsshouldbeconsideredinthecontextofallavailableclinical,histologicalandimmunophenotypicdataVanKrieken,etal.Leukemia2007;21:201-206SuspectedB-cellProliferationsSuspectedLymphoidProliferationsofunknownorigin(BorT)SuspectedT-cellProliferationsIGHB+IGKA+BPreferablywithNoevidence0fpresenceofclonalB/TpopulationinthesameleIGHB+IGKA+BIGHA+C+DIGL+IGHETCRGA+BTCRBA+BTCRBA+B+CTCRBc+TCRDTCRBC+TCRDTCRαβTCRγδIfnotclonalIfnotclonalIfnotclonalLiuetal.BritishJHaematol2007;138：31-43Lineageunknown1.克隆性不等于恶性：有些良性病变有时也有克隆性重排CD8+（有时CD4+)T细胞增生症良性单克隆性r球蛋白病EBV阳性的淋巴细胞增生（AILT)自身免疫性疾病(Sjogren综合症,风湿性关节炎)免疫缺陷状态(先天性,移植后,HIV感染)免疫调节异常疾病（Castleman病）皮肤异常病变（淋巴瘤样丘疹病，急性苔藓样糠疹）结果的解释和注意事项克隆性基因重排在淋巴瘤诊断中的应用ClinicallySuspiciousLNBiopsyMorphologywithIHCIfnecessary,MolecularDxCytogenetics/FISHEvaluationoftheSuspiciousLymphNodeCarcinomav.LymphomaFNAWithFlowCytometrySuspectLymphomaCarcinomaCLLSuspectLymphoma,NegativeorNon-diagnosticWorkupforPrimaryDiagnosisStagingandTreatmentFISHTreatmentNCCNNHLLymphomaGuidelines