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Stanford University School of Medicine

Lymphoma shares secrets in its circulating tumor DNA

syringe-24495_1280It's becoming more and more clear that blood samples can reveal much about a person's tumor. Now hematologist and oncologist Ash Alizadeh, MD, PhD, and radiation oncologist Maximilian Diehn, MD, PhD, along with postdoctoral scholars Florian Scherer, MD, and David Kurtz, MD, and instructor Aaron Newman, PhD, have outlined how they can predict the prognosis, identify the cell of origin and monitor the evolving landscape of mutations in real time in patients with lymphoma by sequencing tiny bits of circulating tumor DNA.

They published their research recently in Science Translational Medicine. 

As I describe in our release:

The researchers conducted a study of 92 prospectively enrolled patients with diffuse large B-cell lymphoma. DLBCL is the most common type of non-Hodgkin lymphoma and is highly biologically variable. As a result, patients vary widely in their response to treatment. About one-third of seemingly successfully treated patients eventually relapse, or their tumors become resistant to treatment. Additionally, a form of indolent B cell lymphoma, which progresses slowly with only mild symptoms, can transform without warning into an aggressive form of the disease.

The researchers used an enhanced version of a technology they developed called CAPP-Seq to predict which seemingly successfully treated patients would relapse, or whose indolent lymphomas were becoming aggressive, months before any clinical signs occurred. They were also able to identify the type of B cell from which the patients' cancers originally sprung--information that plays into each person's prognosis.

As Diehn explained in our release:
In this study we've shown five distinct ways -- by quantifying tumor burden, identifying disease subtype, cataloging mutations, predicting transformation and providing early warnings of recurrence -- that circulating tumor DNA can yield potentially clinically useful information. Now we're eager to conduct prospective studies in recently diagnosed patients to learn how we can best improve patient care.
Alizadeh and Diehn are both investigators at the Ludwig Center for Cancer Stem Cell Research and Medicine at Stanford.

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