Circulating Tumor DNA to Monitor Therapy for Aggressive B-Cell Lymphomas

  • Mary Kwok
  • S. Peter Wu
  • Clifton Mo
  • Thomas Summers
  • Mark Roschewski
Lymphoma (JW Sweetenham, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Lymphoma

Opinion statement

The goal of therapy for aggressive B-cell lymphomas such as diffuse large B-cell lymphoma (DLBCL) and Burkitt lymphoma (BL) is to achieve cure. Combination chemotherapy with rituximab cures most patients, but those with recurrent disease have a poor prognosis. Medical imaging scans such as computed tomography (CT) and positron emission tomography (PET) are the principal methods to assess response and monitor for disease relapse after therapy but are fundamentally limited by risks of radiation, cost, and a lack of tumor specificity. Novel sequencing-based DNA monitoring methods are capable of quantifying small amounts of circulating tumor DNA (ctDNA) before, during, and after therapy for mature B-cell lymphomas. Detection of ctDNA encoding clonal rearranged variable-diversity-joining (VDJ) receptor gene sequences has demonstrated improved analytical sensitivity and enhanced tumor specificity compared to imaging scans in DLBCL, offering broad clinical applicability across a range of aggressive B-cell lymphomas. Molecular monitoring of ctDNA has vaulted into the spotlight as a promising non-invasive tool with immediate clinical impact on monitoring for recurrence after therapy prior to clinical symptoms. As these clinical observations are validated, ctDNA monitoring needs to be investigated as a tool for response-adapted therapy and as a marker of minimal residual disease upon completion of therapy in aggressive B-cell lymphomas. Molecular monitoring of ctDNA holds tremendous promise that may ultimately transform our ability to monitor disease in aggressive B-cell lymphomas.

Keywords

Diffuse large B-cell lymphoma Circulating tumor DNA Minimal residual disease MRD Next-generation sequencing VDJ Liquid biopsy Surveillance imaging Response-adapted 

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Copyright information

© Springer Science+Business Media New York (outside the USA) 2016

Authors and Affiliations

  • Mary Kwok
    • 1
  • S. Peter Wu
    • 2
  • Clifton Mo
    • 1
  • Thomas Summers
    • 3
  • Mark Roschewski
    • 4
  1. 1.Hematology-Oncology DepartmentJohn P. Murtha Cancer Center, Walter Reed National Military Medical CenterBethesdaUSA
  2. 2.Internal Medicine DepartmentPerlmutter Cancer Center, New York University Langone Medical CenterNew YorkUSA
  3. 3.Pathology DepartmentUniformed Services University of the Health SciencesBethesdaUSA
  4. 4.Lymphoid Malignancies Branch, Center for Cancer ResearchNational Cancer Institute, National Institutes of HealthBethesdaUSA

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