The benefit of quality control charts (QCC) for routine quantitative BCR-ABL1 monitoring in chronic myeloid leukemia

PLoS One. 2018 Apr 24;13(4):e0196326. doi: 10.1371/journal.pone.0196326. eCollection 2018.

Abstract

Quantitative real-time polymerase chain reaction (qRT-PCR) is state of the art in molecular monitoring of minimal residual disease in chronic myeloid leukemia (CML). In this context, maintenance of assay fidelity and detection of technical inaccuracy are crucial. Beside multiple common negative controls for the clinical sample preparations, quality control charts (QCC) are a common validation tool to sustain high process quality by continuously recording of qRT-PCR control parameters. Here, we report on establishment and benefit of QCC in qRT-PCR-based CML diagnostics. The absolute quantification of BCR-ABL1 fusion transcripts in patient samples is based on coamplification of a serially diluted reference plasmid (pME-2). For QCC establishment the measured Ct values of each pME-2 standard dilution (4-400,000) of a test set resembling 21 sequential qRT-PCR experiments were recorded and statistically evaluated. Test set data were used for determination of warning limits (mean +/- 2-fold standard deviation) and control (intervention) limits (mean +/- 3-fold standard deviation) to allow rapid detection of defined out-of-control situations which may require intervention. We have retrospectively analyzed QCC data of 282 sequential qRT-PCR experiments (564 reactions). Data evaluation using QCCs revealed three out-of-control situations that required intervention like experiment repeats, renewal of pME-2 standards, replacement of reagents or personnel re-training. In conclusion, with minimal more effort and hands-on time QCC rank among the best tools to grant high quality and reproducibility in CML routine molecular diagnosis.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Case-Control Studies
  • Diagnostic Tests, Routine* / methods
  • Diagnostic Tests, Routine* / standards
  • Fusion Proteins, bcr-abl / analysis*
  • Fusion Proteins, bcr-abl / genetics
  • Humans
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / diagnosis*
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / genetics
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / pathology
  • Medical Records / standards
  • Molecular Diagnostic Techniques / standards
  • Monitoring, Physiologic / methods
  • Monitoring, Physiologic / standards
  • Neoplasm, Residual
  • Predictive Value of Tests
  • Quality Control*
  • Real-Time Polymerase Chain Reaction* / standards
  • Reference Standards
  • Reproducibility of Results
  • Retrospective Studies
  • Software Design

Substances

  • Fusion Proteins, bcr-abl

Grants and funding

SS received honoraria from Novartis Pharma GmbH, Bristol-Myers Squibb (BMS), Pfizer, ARIAD and research funding from Novartis Pharma GmbH and BMS. This does not alter our adherence to PLOS ONE policies on sharing data and materials. The funders had no role in study design, collection, analysis and interpretation of data; writing of the paper and/or decision to submit for publication. We further acknowledge financial support by Deutsche Forschungsgemeinschaft within the funding programme Open Access Publishing, by the Baden-Württemberg Ministry of Science, Research and the Arts and by Ruprecht-Karls-Universität Heidelberg.