Lymphoma, Large B-Cell, Diffuse Clinical Trial
Official title:
Non-invasive Tumor Immunoglobulin Gene Next Generation Sequencing (IgNGS) in Diffuse Large B Cell Lymphoma (DLBCL): Prognostic Implications and Assessment of Tumor Response
This study will evaluate IgNGS at different time points in newly diagnosed DLBCL patients homogeneously treated (RCHOP) to address its correlation with conventional techniques (i.e., positron emission tomography/computed tomography imaging (PET/CT) and outcome.
In B-cell malignancies, every lymphocyte clone expresses a unique antigen receptor structure,
therefore immunoglobulin gene rearrangements (the sequence of nucleotides at the V(D)J
recombination site) serves as a specific marker for each clone. Methods of analysis have
changed over time to improve the sensitivity and to allow its application in clinical
settings.
Diffuse Large B-cell lymphoma (DLBCL) displays molecular heterogeneity. In this context,
IgNGS allows for detection of tumor clonotype from plasma (ctDNA) (Liquid Biopsy-LB) of DLBCL
patients with high sensitivity and specificity. ctDNA can be tracked with this methodology in
the vast majority (>90%) of patients, in contrast to NGS-methods based on genotyping for
specific DLBCL mutations, which have overall low frequency. Furthermore, most newly
discovered neoantigens in lymphoma derive from immunoglobulin variable sequences, supporting
the relevance of the analysis of this particular region in contrast to the use of specific
B-cell mutations. Importantly, preliminary studies on clonotype detection by IgNGS at the end
of treatment correlate with outcome (poorer progression-free survival) and the persistence or
reemergence of the tumor clonotype by ctDNA studies may anticipate the clinical relapse. We
propose to evaluate IgNGS at different time points in newly diagnosed DLBCL patients treated
with RCHOP to address its correlation with conventional techniques (i.e., PET/CT imaging) and
outcome.
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