Molecular Monitoring in CML the process and questions we can answer Letizia Foroni.
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Transcript of Molecular Monitoring in CML the process and questions we can answer Letizia Foroni.
![Page 1: Molecular Monitoring in CML the process and questions we can answer Letizia Foroni.](https://reader033.fdocuments.us/reader033/viewer/2022051622/5697c0251a28abf838cd5636/html5/thumbnails/1.jpg)
Molecular Monitoring in CML
the process and questions we can
answer
Letizia Foroni
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Aims
•Review laboratory tests used for the diagnosis of CML
•Review the information provided by PCR
•Stopping treatment: how can molecular test help to decide
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Process of analysis
Sample collectionand analysis
Sample examination
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The first step: look down a microscope!
Increased number of one type of cells, the granulocytes o called because they contain a lot of granules!
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Other diagnostic tools to confirm the diagnosis?
Cytogenetic analysis
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Chr 9
Chr 22: Ph chromosome
Cytogenetics: Philadelphia chromosome
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Philadelphia chromosome
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Other diagnostic tools to confirm the diagnosis?
Molecular analysis
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Sample processing and RNA extraction
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PCR analysis
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Molecular Monitoring post TKI therapy
Are the remaining blood cells normal or leukaemic?
For this we require a very sensitive methodology:Real Time PCR or Quantitative PCR
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BCR-ABL1: FU analysisReal time quantitative PCR
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What information does the PCR test
provide?
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PCR results
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PCR results
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ConversionFactor
PCR and International Scale Values
Lab 1
Lab 2
Lab 3
Procedure 1
Procedure 2
Procedure 3
Reference material
0.75
0.55
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Effect of Conversion factor/s on tests from different laboratories
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Monitoring CML summary
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European Leukaemia Network Guidelines
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When is it important to test?
•At diagnosis
•Every 3 months for at least the first 2 years (general practice) but to be discussed with your clinical team.
•Every 6 months after 2 years.
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Monitoring CML summary
CAN we stop?
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The best method to use
to decide when is best to stop
Which and when?
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Digital PCR
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ConclusionsConclusions•PCR provides the most sensitive method to monitor disease
•Samples at 3 months and every three months predict future outcome
•Digital PCR is helping to identify patients who can consider stopping therapy