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Alcoceba M, Stewart JP, García-Álvarez M, Díaz LG, Jiménez C, Medina A, Chillón MC, Gazdova J, Blanco O, Díaz FJ, Peñarrubia MJ, Fernández S, Montes C, Cabero A, Caballero MD, García-Sanz R, González M, González D, Tamayo P, Gutiérrez NC, García-Sancho AM, Sarasquete ME. Liquid biopsy for molecular characterization of diffuse large B-cell lymphoma and early assessment of minimal residual disease. Br J Haematol 2024; 205:109-121. [PMID: 38811363 DOI: 10.1111/bjh.19458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 03/01/2024] [Accepted: 04/01/2024] [Indexed: 05/31/2024]
Abstract
Circulating tumour DNA (ctDNA) allows genotyping and minimal residual disease (MRD) detection in lymphomas. Using a next-generation sequencing (NGS) approach (EuroClonality-NDC), we evaluated the clinical and prognostic value of ctDNA in a series of R-CHOP-treated diffuse large B-cell lymphoma (DLBCL) patients at baseline (n = 68) and after two cycles (n = 59), monitored by metabolic imaging (positron emission tomography combined with computed tomography [PET/CT]). A molecular marker was identified in 61/68 (90%) ctDNA samples at diagnosis. Pretreatment high ctDNA levels significantly correlated with elevated lactate dehydrogenase, advanced stage, high-risk International Prognostic Index and a trend to shorter 2-year progression-free survival (PFS). Valuable NGS data after two cycles of treatment were obtained in 44 cases, and 38 achieved major molecular response (MMR; 2.5-log drop in ctDNA). PFS curves displayed statistically significant differences among those achieving MMR versus those not achieving MMR (2-year PFS of 76% vs. 0%, p < 0.001). Similarly, more than 66% reduction in ΔSUVmax by PET/CT identified two subgroups with different prognosis (2-year PFS of 83% vs. 38%; p < 0.001). Combining both approaches MMR and ΔSUVmax reduction, a better stratification was observed (2-year PFS of 84% vs. 17% vs. 0%, p < 0.001). EuroClonality-NDC panel allows the detection of a molecular marker in the ctDNA in 90% of DLBCL. ctDNA reduction at two cycles and its combination with interim PET results improve patient prognosis stratification.
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MESH Headings
- Humans
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/blood
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Neoplasm, Residual/diagnosis
- Female
- Male
- Middle Aged
- Aged
- Adult
- Circulating Tumor DNA/blood
- Circulating Tumor DNA/genetics
- Liquid Biopsy/methods
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Aged, 80 and over
- Positron Emission Tomography Computed Tomography
- Rituximab/therapeutic use
- Rituximab/administration & dosage
- Cyclophosphamide/therapeutic use
- Cyclophosphamide/administration & dosage
- Biomarkers, Tumor/blood
- Vincristine/therapeutic use
- Vincristine/administration & dosage
- Prognosis
- Doxorubicin/therapeutic use
- Doxorubicin/administration & dosage
- High-Throughput Nucleotide Sequencing
- Prednisone/therapeutic use
- Prednisone/administration & dosage
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Affiliation(s)
- Miguel Alcoceba
- Servicio de Hematologia, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, y Centro de Investigacion del Cancer de Salamanca-IBMCC (USAL-CSIC), Salamanca, Spain
- Grupo de trabajo cooperativo de linfomas y procesos linfoproliferativos de la SCLHH, Castilla y León, Spain
| | - James P Stewart
- Patrick G Johnston Centre for Cancer Research, Queens University Belfast, Belfast, UK
| | - María García-Álvarez
- Servicio de Hematologia, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, y Centro de Investigacion del Cancer de Salamanca-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Luis G Díaz
- Servicio de Medicina Nuclear, Hospital Universitario de Salamanca (HUS/IBSAL), Salamanca, Spain
| | - Cristina Jiménez
- Servicio de Hematologia, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, y Centro de Investigacion del Cancer de Salamanca-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Alejandro Medina
- Servicio de Hematologia, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, y Centro de Investigacion del Cancer de Salamanca-IBMCC (USAL-CSIC), Salamanca, Spain
| | - M Carmen Chillón
- Servicio de Hematologia, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, y Centro de Investigacion del Cancer de Salamanca-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Jana Gazdova
- Patrick G Johnston Centre for Cancer Research, Queens University Belfast, Belfast, UK
| | - Oscar Blanco
- Servicio de Anatomía Patológica, Hospital Universitario de Salamanca (HUS/IBSAL), Salamanca, Spain
| | - Francisco J Díaz
- Servicio de Hematologia, Complejo Asistencial de Burgos, Burgos, Spain
| | - María J Peñarrubia
- Servicio de Hematologia, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Silvia Fernández
- Servicio de Hematologia, Complejo Asistencial Universitario de León, León, Spain
| | - Carlos Montes
- Servicio de Radiofísica y Protección Radiológica, Hospital Universitario de Salamanca (HUS/IBSAL), Salamanca, Spain
| | - Almudena Cabero
- Servicio de Hematologia, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, y Centro de Investigacion del Cancer de Salamanca-IBMCC (USAL-CSIC), Salamanca, Spain
- Grupo de trabajo cooperativo de linfomas y procesos linfoproliferativos de la SCLHH, Castilla y León, Spain
| | - María D Caballero
- Servicio de Hematologia, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, y Centro de Investigacion del Cancer de Salamanca-IBMCC (USAL-CSIC), Salamanca, Spain
- Grupo de trabajo cooperativo de linfomas y procesos linfoproliferativos de la SCLHH, Castilla y León, Spain
| | - Ramón García-Sanz
- Servicio de Hematologia, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, y Centro de Investigacion del Cancer de Salamanca-IBMCC (USAL-CSIC), Salamanca, Spain
- Grupo de trabajo cooperativo de linfomas y procesos linfoproliferativos de la SCLHH, Castilla y León, Spain
| | - Marcos González
- Servicio de Hematologia, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, y Centro de Investigacion del Cancer de Salamanca-IBMCC (USAL-CSIC), Salamanca, Spain
- Grupo de trabajo cooperativo de linfomas y procesos linfoproliferativos de la SCLHH, Castilla y León, Spain
| | - David González
- Patrick G Johnston Centre for Cancer Research, Queens University Belfast, Belfast, UK
| | - Pilar Tamayo
- Servicio de Medicina Nuclear, Hospital Universitario de Salamanca (HUS/IBSAL), Salamanca, Spain
| | - Norma C Gutiérrez
- Servicio de Hematologia, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, y Centro de Investigacion del Cancer de Salamanca-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Alejandro Martín García-Sancho
- Servicio de Hematologia, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, y Centro de Investigacion del Cancer de Salamanca-IBMCC (USAL-CSIC), Salamanca, Spain
- Grupo de trabajo cooperativo de linfomas y procesos linfoproliferativos de la SCLHH, Castilla y León, Spain
| | - M Eugenia Sarasquete
- Servicio de Hematologia, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, y Centro de Investigacion del Cancer de Salamanca-IBMCC (USAL-CSIC), Salamanca, Spain
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Abstract
PURPOSE OF REVIEW Functional imaging with 18FDG-PET-CT has transformed the staging and response assessment of patients with Hodgkin (HL) and non-Hodgkin lymphoma (NHL). Herein, we review the current role and future directions for functional imaging in the management of patients with lymphoma. RECENT FINDINGS Because of its increased sensitivity, PET-CT is the preferred modality for staging of FDG-avid lymphomas. It appears to have a role for interim assessment in patients with HL with adaptive strategies that reduce toxicity in lower risk patients and increase efficacy in those at high risk. Such a role has yet to be demonstrated in other histologies. FDG-PET-CT is also the gold standard for response assessment posttreatment. Newer uses include assessment of total metabolic tumor volume and radiomics in pretreatment prognosis. Whereas PET-CT is more sensitive than other current modalities for staging and response assessment, the future of PET-CT will be in conjunction with other modalities, notably assessment of minimal residual disease and microenvironmental markers to develop risk adaptive strategies to improve the outcome of patients with lymphoma.
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Nakata J, Isohashi K, Oka Y, Nakajima H, Morimoto S, Fujiki F, Oji Y, Tsuboi A, Kumanogoh A, Hashimoto N, Hatazawa J, Sugiyama H. Imaging Assessment of Tumor Response in the Era of Immunotherapy. Diagnostics (Basel) 2021; 11:diagnostics11061041. [PMID: 34198874 PMCID: PMC8226723 DOI: 10.3390/diagnostics11061041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/29/2021] [Accepted: 06/03/2021] [Indexed: 02/07/2023] Open
Abstract
Assessment of tumor response during treatment is one of the most important purposes of imaging. Before the appearance of immunotherapy, response evaluation criteria in solid tumors (RECIST) and positron emission tomography response criteria in solid tumors (PERCIST) were, respectively, the established morphologic and metabolic response criteria, and cessation of treatment was recommended when progressive disease was detected according to these criteria. However, various types of immunotherapy have been developed over the past 20 years, which show novel false positive findings on images, as well as distinct response patterns from conventional therapies. Antitumor immune response itself causes 18F-fluorodeoxyglucose (FDG) uptake in tumor sites, known as "flare phenomenon", so that positron emission tomography using FDG can no longer accurately identify remaining tumors. Furthermore, tumors often initially increase, followed by stability or decrease resulting from immunotherapy, which is called "pseudoprogression", so that progressive disease cannot be confirmed by computed tomography or magnetic resonance imaging at a single time point. As a result, neither RECIST nor PERCIST can accurately predict the response to immunotherapy, and therefore several new response criteria fixed for immunotherapy have been proposed. However, these criteria are still controversial, and also require months for response confirmation. The establishment of optimal response criteria and the development of new imaging technologies other than FDG are therefore urgently needed. In this review, we summarize the false positive images and the revision of response criteria for each immunotherapy, in order to avoid discontinuation of a truly effective immunotherapy.
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Affiliation(s)
- Jun Nakata
- Department of Clinical Laboratory and Biomedical Sciences, Osaka University Graduate School of Medicine, Suita City 565-0871, Osaka, Japan;
- Correspondence: ; Tel.: +81-6-6879-3676; Fax: +81-6-6879-3677
| | - Kayako Isohashi
- Department of Kansai BNCT Medical Center, Osaka Medical and Pharmaceutical University, Takatsuki City 596-8686, Osaka, Japan;
| | - Yoshihiro Oka
- Department of Cancer Stem Cell Biology, Osaka University Graduate School of Medicine, Suita City 565-0871, Osaka, Japan;
- Department of Immunopathology, WP1 Immunology Frontier Research Center, Osaka University, Suita City 565-0871, Osaka, Japan;
| | - Hiroko Nakajima
- Department of Cancer Immunology, Osaka University Graduate School of Medicine, Suita City 565-0871, Osaka, Japan; (H.N.); (F.F.); (H.S.)
| | - Soyoko Morimoto
- Department of Cancer Immunotherapy, Osaka University Graduate School of Medicine, Suita City 565-0871, Osaka, Japan; (S.M.); (A.T.)
| | - Fumihiro Fujiki
- Department of Cancer Immunology, Osaka University Graduate School of Medicine, Suita City 565-0871, Osaka, Japan; (H.N.); (F.F.); (H.S.)
| | - Yusuke Oji
- Department of Clinical Laboratory and Biomedical Sciences, Osaka University Graduate School of Medicine, Suita City 565-0871, Osaka, Japan;
| | - Akihiro Tsuboi
- Department of Cancer Immunotherapy, Osaka University Graduate School of Medicine, Suita City 565-0871, Osaka, Japan; (S.M.); (A.T.)
| | - Atsushi Kumanogoh
- Department of Immunopathology, WP1 Immunology Frontier Research Center, Osaka University, Suita City 565-0871, Osaka, Japan;
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Suita City 565-0871, Osaka, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University Graduate School of Medicine, Suita City 565-0871, Osaka, Japan
| | - Naoya Hashimoto
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto City 602-8566, Kyoto, Japan;
| | - Jun Hatazawa
- Department of Research Center for Nuclear Physics, Osaka University Graduate School of Medicine, Suita City 565-0871, Osaka, Japan;
| | - Haruo Sugiyama
- Department of Cancer Immunology, Osaka University Graduate School of Medicine, Suita City 565-0871, Osaka, Japan; (H.N.); (F.F.); (H.S.)
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Abuelgasim KA, Shammari RA, Alshieban S, Alahmari B, Alzahrani M, Alhejazi A, Alaskar A, Damlaj M. Impact of cluster of differentiation 20 expression and rituximab therapy in classical Hodgkin lymphoma: Real world experience. Leuk Res Rep 2021; 15:100240. [PMID: 33936943 PMCID: PMC8076710 DOI: 10.1016/j.lrr.2021.100240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 03/25/2021] [Accepted: 04/05/2021] [Indexed: 11/17/2022] Open
Abstract
The prognostic impact of CD20 expression and rituximab therapy in classical Hodgkin lymphoma (cHL) is unclear. Among 310 patients, CD20 was expressed in 66 (22%) cases. The 3-year PFS was 75.1% for CD20+and 70% for CD20− (p = 0.36). The 3-year PFS was 84.7% for the rituximab group and 67.8% for the no rituximab group (p = 0.23). Only constitutional symptoms and positive interim PET/CT were significantly associated with worse outcome, HR 3.2 (1.14–9.01; p = 0.028) and 4.3 (2.27–8.1; p < 0.0001), respectively. Neither CD20 expression nor rituximab use significantly impacted outcome.
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Affiliation(s)
- Khadega A Abuelgasim
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Oncology Department, King Abdulaziz Medical City, Riyadh National Guard Health Affairs, Riyadh 11426, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Raed Al Shammari
- Internal Medicine Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Saeed Alshieban
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Pathology Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Bader Alahmari
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Oncology Department, King Abdulaziz Medical City, Riyadh National Guard Health Affairs, Riyadh 11426, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohsen Alzahrani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Oncology Department, King Abdulaziz Medical City, Riyadh National Guard Health Affairs, Riyadh 11426, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ayman Alhejazi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Oncology Department, King Abdulaziz Medical City, Riyadh National Guard Health Affairs, Riyadh 11426, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmed Alaskar
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Oncology Department, King Abdulaziz Medical City, Riyadh National Guard Health Affairs, Riyadh 11426, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Moussab Damlaj
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Oncology Department, King Abdulaziz Medical City, Riyadh National Guard Health Affairs, Riyadh 11426, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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