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Pulsoni A, Ferrero S, Tosti ME, Luminari S, Dondi A, Cavallo F, Merli F, Liberati AM, Cenfra N, Renzi D, Zanni M, Boccomini C, Ferreri AJM, Rattotti S, Zilioli VR, Bolis SA, Bernuzzi P, Musuraca G, Gaidano G, Perrone T, Stelitano C, Tucci A, Corradini P, Bigliardi S, Re F, Cencini E, Mannarella C, Mannina D, Celli M, Tani M, Annechini G, Assanto GM, Grapulin L, Guarini A, Cavalli M, De Novi LA, Bomben R, Ciabatti E, Genuardi E, Drandi D, Della Starza I, Arcaini L, Ricardi U, Gattei V, Galimberti S, Ladetto M, Foà R, Del Giudice I. Local radiotherapy and measurable residual disease-driven immunotherapy in patients with early-stage follicular lymphoma (FIL MIRO): final results of a prospective, multicentre, phase 2 trial. Lancet Haematol 2024; 11:e499-e509. [PMID: 38937025 DOI: 10.1016/s2352-3026(24)00143-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND The mainstay of treatment for early-stage follicular lymphoma is local radiotherapy, with a possible role for anti-CD20 monoclonal antibody (mAb). We aimed to evaluate the effect of these treatments using a measurable residual disease (MRD)-driven approach. METHODS This prospective, multicentre, phase 2 trial was conducted at 27 centres of the Fondazione Italiana Linfomi (FIL) in Italy. Eligible participants were adults (≥18 years) with newly diagnosed, histologically confirmed follicular lymphoma (stage I or II; grade I-IIIa). Patients were initially treated with 24 Gy involved-field radiotherapy over 12 days; those who were MRD-positive after radiotherapy or during follow-up received eight intravenous doses (1000 mg per dose; one dose per week) of the anti-CD20 mAb ofatumumab. The primary endpoint was the proportion of patients who were MRD-positive after involved-field radiotherapy and became MRD-negative after ofatumumab treatment. Patients were included in the primary endpoint analysis population if they were positive for BCL2::IGH rearrangement at enrolment in peripheral blood or bone marrow samples. MRD positivity was defined as the persistence of BCL2::IGH rearrangement in peripheral blood or bone marrow, assessed centrally by laboratories of the FIL MRD Network. The trial was registered with EudraCT, 2012-001676-11. FINDINGS Between May 2, 2015, and June 1, 2018, we enrolled 110 participants, of whom 106 (96%) were eligible and received involved-field radiotherapy. Of these, 105 (99%) were White, one (1%) was Black, 50 (47%) were male, and 56 (53%) were female. Of 105 participants in whom BCL2::IGH status was evaluable, 32 (30%) had a detectable BCL2::IGH rearrangement at baseline. After radiotherapy, 12 (40%) of 30 patients reached MRD-negative status, which was long-lasting (at least 36 or 42 months) in three (25%). In those who were MRD-positive after radiotherapy, ofatumumab induced MRD-negativity in 23 (92%; 95% CI 74-99) of 25 evaluable patients. After a median follow-up of 46·1 months (IQR 42·8-50·8), 14 (61%) of these 23 patients remain in complete response and are MRD-negative. The most common grade 3-4 adverse events were infusion-related reactions, observed in four patients. INTERPRETATION Local radiotherapy is frequently not associated with the eradication of follicular lymphoma. An MRD-driven, anti-CD20 monoclonal antibody consolidation enables molecular remission to be reached in almost all patients and is associated with a reduced incidence of relapse over time. A clinical advantage of an MRD-driven consolidation is therefore suggested. FUNDING AIRC Foundation for Cancer Research in Italy, Novartis International, and GlaxoSmithKline.
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Affiliation(s)
- Alessandro Pulsoni
- Hematology, Department of Translational and Precision Medicine, Sapienza University-Polo Pontino, S.M. Goretti Hospital, Latina, Italy.
| | - Simone Ferrero
- Hematology Division, Department of Molecular Biotechnologies and Health Sciences, University of Torino/AOU "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Maria Elena Tosti
- Istituto Superiore di Sanità, National Center for Global Health, Rome, Italy
| | - Stefano Luminari
- Hematology Unit, Arcispedale S Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy; Department CHIMOMO, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | | | - Federica Cavallo
- Hematology Division, Department of Molecular Biotechnologies and Health Sciences, University of Torino/AOU "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Francesco Merli
- Hematology Unit, Arcispedale S Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | | | - Natalia Cenfra
- Hematology Unit, S Maria Goretti Hospital, AUSL Latina, Latina, Italy
| | - Daniela Renzi
- Hematology and Stem Cells Transplantation Unit, IRCCS Istituto Nazionale dei Tumori Regina Elena, Rome, Italy
| | - Manuela Zanni
- Division of Hematology, SS Antonio e Biagio Hospital, Alessandria, Italy
| | - Carola Boccomini
- SC Hematology, AOU Città della Salute e della Scienza, Turin, Italy
| | - Andrés J M Ferreri
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy
| | - Sara Rattotti
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Silvia Anna Bolis
- Struttura Complessa di Ematologia, Fondazione IRCCS San Gerardo dei Tintori-Monza, Monza, Italy
| | - Patrizia Bernuzzi
- Hematology Unit, Department of Onco-Hematology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Gerardo Musuraca
- Hematology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Tommasina Perrone
- Unit of Hematology with Transplantation, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Caterina Stelitano
- Department of Hematology, Azienda Ospedaliera Bianchi Melacrinò Morelli, Reggio Calabria, Italy
| | | | - Paolo Corradini
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Sara Bigliardi
- Onco-Hematology Department, Nuovo Ospedale Civile di Sassuolo, Sassuolo, Italy
| | | | - Emanuele Cencini
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy
| | | | - Donato Mannina
- Department of Hematology, Azienda Ospedaliera Papardo, Messina, Italy
| | | | - Monica Tani
- Hematology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Giorgia Annechini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giovanni Manfredi Assanto
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Lavinia Grapulin
- Department of Radiotherapy, AOU Policlinico Umberto I, Rome, Italy
| | - Anna Guarini
- Hematology, Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Marzia Cavalli
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Lucia Anna De Novi
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco-Hematology Unit, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Elena Ciabatti
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elisa Genuardi
- Hematology Division, Department of Molecular Biotechnologies and Health Sciences, University of Torino/AOU "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Daniela Drandi
- Hematology Division, Department of Molecular Biotechnologies and Health Sciences, University of Torino/AOU "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Irene Della Starza
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy; AIL Roma, ODV, Rome, Italy
| | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Umberto Ricardi
- Radiation Oncology, Department of Oncology, University of Turin, Turin, Italy
| | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Sara Galimberti
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Ladetto
- Department of Translational Medicine, SCDU Ematologia AO SS Antonio e Biagio E Cesare Arrigo, Università del Piemonte Orientale, Alessandria, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
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Leeman-Neill RJ, Bhagat G, Basu U. AID in non-Hodgkin B-cell lymphomas: The consequences of on- and off-target activity. Adv Immunol 2024; 161:127-164. [PMID: 38763700 DOI: 10.1016/bs.ai.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
Activation induced cytidine deaminase (AID) is a key element of the adaptive immune system, required for immunoglobulin isotype switching and affinity maturation of B-cells as they undergo the germinal center (GC) reaction in peripheral lymphoid tissue. The inherent DNA damaging activity of this enzyme can also have off-target effects in B-cells, producing lymphomagenic chromosomal translocations that are characteristic features of various classes of non-Hodgkin B-cell lymphoma (B-NHL), and generating oncogenic mutations, so-called aberrant somatic hypermutation (aSHM). Additionally, AID has been found to affect gene expression through demethylation as well as altered interactions between gene regulatory elements. These changes have been most thoroughly studied in B-NHL arising from GC B-cells. Here, we describe the most common classes of GC-derived B-NHL and explore the consequences of on- and off-target AID activity in B and plasma cell neoplasms. The relationships between AID expression, including effects of infection and other exposures/agents, mutagenic activity and lymphoma biology are also discussed.
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Affiliation(s)
- Rebecca J Leeman-Neill
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States; Department of Microbiology and Immunology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States.
| | - Govind Bhagat
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Uttiya Basu
- Department of Microbiology and Immunology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
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Ferrero S, Grimaldi D, Genuardi E, Drandi D, Zaccaria GM, Alessandria B, Ghislieri M, Ferrante M, Evangelista A, Mantoan B, De Luca G, Stefani PM, Benedetti F, Casaroli I, Zanni M, Castellino C, Pavone V, Petrini M, Re F, Hohaus S, Musuraca G, Cascavilla N, Ghiggi C, Liberati AM, Cortelazzo S, Ladetto M. Punctual and kinetic MRD analysis from the Fondazione Italiana Linfomi MCL0208 phase 3 trial in mantle cell lymphoma. Blood 2022; 140:1378-1389. [PMID: 35737911 PMCID: PMC9507010 DOI: 10.1182/blood.2021014270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/27/2022] [Indexed: 11/20/2022] Open
Abstract
Minimal residual disease (MRD) analysis is a known predictive tool in mantle cell lymphoma (MCL). We describe MRD results from the Fondazione Italiana Linfomi phase 3 MCL0208 prospective clinical trial assessing lenalidomide (LEN) maintenance vs observation after autologous stem cell transplantation (ASCT) in the first prospective comprehensive analysis of different techniques, molecular markers, and tissues (peripheral blood [PB] and bone marrow [BM]), taken at well-defined time points. Among the 300 patients enrolled, a molecular marker was identified in 250 (83%), allowing us to analyze 234 patients and 4351 analytical findings from 10 time points. ASCT induced high rates of molecular remission (91% in PB and 83% in BM, by quantitative real-time polymerase chain reaction [RQ-PCR]). Nevertheless, the number of patients with persistent clinical and molecular remission decreased over time in both arms (up to 30% after 36 months). MRD predicted early progression and long-term outcome, particularly from 6 months after ASCT (6-month time to progression [TTP] hazard ratio [HR], 3.83; P < .001). In single-timepoint analysis, BM outperformed PB, and RQ-PCR was more reliable, while nested PCR appeared applicable to a larger number of patients (234 vs 176). To improve MRD performance, we developed a time-varying kinetic model based on regularly updated MRD results and the MIPI (Mantle Cell Lymphoma International Prognostic Index), showing an area under the ROC (Receiver Operating Characteristic) curve (AUROC) of up to 0.87 using BM. Most notably, PB reached an AUROC of up to 0.81; with kinetic analysis, it was comparable to BM in performance. MRD is a powerful predictor over the entire natural history of MCL and is suitable for models with a continuous adaptation of patient risk. The study can be found in EudraCT N. 2009-012807-25 (https://eudract.ema.europa.eu/).
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Affiliation(s)
- Simone Ferrero
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
- AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Daniele Grimaldi
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
- Hematology Division, AO S.Croce e Carle, Cuneo, Italy
| | - Elisa Genuardi
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Daniela Drandi
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Gian Maria Zaccaria
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Beatrice Alessandria
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Marco Ghislieri
- PoliToBIOMed Lab, Politecnico di Torino, Torino, Italy
- Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Martina Ferrante
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Andrea Evangelista
- Unit of Cancer Epidemiology, CPO, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Barbara Mantoan
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Gabriele De Luca
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | | | - Fabio Benedetti
- Department of Medicine, Section of Hematology and Bone Marrow Transplant Unit, University of Verona, Verona, Italy
| | | | - Manuela Zanni
- Division of Hematology, Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | | | | | | | - Francesca Re
- Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Stefan Hohaus
- Hematology Unit, Università Cattolica S.Cuore; Roma, Italy
| | - Gerardo Musuraca
- Department of Hematology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS
| | - Nicola Cascavilla
- Hematology, Casa Sollievo della Sofferenza IRCCS Hospital, San Giovanni Rotondo, Italy
| | - Chiara Ghiggi
- Department of Hematology, San Martino Hospital and University, Genova, Italy
| | - Anna Marina Liberati
- Department of Hematology, A.O. Santa Maria Terni, University of Perugia, Perugia, Italy; and
| | | | - Marco Ladetto
- Division of Hematology, Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
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Genuardi E, Alessandria B, Civita AM, Ferrero S. Targeted Locus Amplification as Marker Screening Approach to Detect Immunoglobulin (IG) Translocations in B-Cell Non-Hodgkin Lymphomas. METHODS IN MOLECULAR BIOLOGY (CLIFTON, N.J.) 2022; 2453:119-132. [PMID: 35622324 DOI: 10.1007/978-1-0716-2115-8_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although MRD monitoring by the classic polymerase chain reaction (PCR) approach is a powerful outcome predictor, about 20% of mantle cell lymphoma (MCL) and 50% of follicular lymphoma (FL) patients still lack a molecular marker and are thus resulting not eligible for MRD monitoring. Targeted locus amplification (TLA), a new NGS technology, has been revealed as a feasible marker screening approach able to identify uncommon B-cell leukemia/lymphoma 1 (BCL1) and B-cell leukemia/lymphoma 2 (BCL2) rearrangements in MCL and FL cases defined as having "no marker" by the classic PCR approach.
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Affiliation(s)
- Elisa Genuardi
- Hematology Division, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Beatrice Alessandria
- Hematology Division, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Aurora Maria Civita
- Hematology Division, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Simone Ferrero
- Hematology Division, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy. .,Hematology Division, AOU "Città della Salute e della Scienza di Torino", Torino, Italy.
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Fan Y, Chen W, Wei R, Qiang W, Pearson JD, Yu T, Bremner R, Chen D. Mapping transgene insertion sites reveals the α-Cre transgene expression in both developing retina and olfactory neurons. Commun Biol 2022; 5:411. [PMID: 35505181 PMCID: PMC9065156 DOI: 10.1038/s42003-022-03379-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 04/18/2022] [Indexed: 02/05/2023] Open
Abstract
The Tg(Pax6-cre,GFP)2Pgr (α-Cre) mouse is a commonly used Cre line thought to be retinal-specific. Using targeted locus amplification (TLA), we mapped the insertion site of the transgene, and defined primers useful to deduce zygosity. Further analyses revealed four tandem copies of the transgene. The insertion site mapped to clusters of vomeronasal and olfactory receptor genes. Using R26R and Ai14 Cre reporter mice, we confirmed retinal Cre activity, but also detected expression in Gα0+ olfactory neurons. Most α-Cre+ olfactory neurons do not express Pax6, implicating the influence of neighboring regulatory elements. RT-PCR and buried food pellet test did not detect any effects of the transgene on flanking genes in the nasal mucosa and retina. Together, these data precisely map α-Cre, show that it does not affect surrounding loci, but reveal previously unanticipated transgene expression in olfactory neurons. The α-Cre mouse can be a valuable tool in both retinal and olfactory research. The Pax6-α-Cre mouse line used in retinal studies actually contains four transgene insertion within gene clusters of olfactory and vomeronasal receptors, leading to expression in not just retinal, but also olfactory and vomeronasal sensory neurons.
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Affiliation(s)
- Yimeng Fan
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.,Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Wenyue Chen
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.,Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Ran Wei
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.,Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Qiang
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.,Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Joel D Pearson
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, and Departments of Ophthalmology and Visual Science, and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Tao Yu
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, and Departments of Ophthalmology and Visual Science, and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Rod Bremner
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, and Departments of Ophthalmology and Visual Science, and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
| | - Danian Chen
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China. .,Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China. .,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, and Departments of Ophthalmology and Visual Science, and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
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Giudice ID, Starza ID, Foà R. Does MRD have a role in the management of iNHL? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:320-330. [PMID: 34889425 PMCID: PMC8791119 DOI: 10.1182/hematology.2021000312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Among indolent non-Hodgkin lymphomas (iNHLs), the analysis of measurable/minimal residual disease (MRD) has been extensively applied to follicular lymphoma (FL). Treatment combinations have deeply changed over the years, as well as the techniques to measure MRD, which is currently evaluated only in the setting of clinical trials. Here, we discuss the evidence on the role of molecular monitoring in the management of FL. Mature data support the quantification of molecular tumor burden at diagnosis as a tool to stratify patients in risk categories and of MRD evaluation at the end of treatment to predict progression-free survival and overall survival. Moreover, MRD deserves further studies as a tool to refine the clinical/metabolic response and to modulate treatment intensity/duration. Patients with a higher relapse probability can be identified, but the relevance of continuous molecular follow-up should be clarified by kinetic models of MRD analysis. Being the BCL2/heavy chain immunoglobulin gene hybrid rearrangement detectable in about 50% to 60% of advanced FL and in 30% of positron emission tomography/computed tomography-staged localized FL, technical advancements such as next-generation sequencing/target locus amplification may allow broadening the FL population carrying a molecular marker. Droplet digital polymerase chain reaction can better quantify MRD at low levels, and novel sources of DNA, such as cell-free DNA, may represent a noninvasive tool to monitor MRD. Finally, MRD in other iNHLs, such as lymphoplasmacytic lymphoma/Waldenström macroglobulinemia and marginal zone lymphoma, is beginning to be explored.
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Affiliation(s)
- Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Irene Della Starza
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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