Reid Merryman, MD, on Study Findings Investigating Prognostic Value of ctDNA for Patients with DLBCL

Reid Merryman, MD, of the Dana-Farber Cancer Institute, spoke with CancerNetwork® about the findings from an oral presentation investigating the prognostic value of circulating tumor DNA among patients with diffuse large B cell lymphoma (DLBCL) presented at the 2020 American Society of Hematology (ASH) Annual Meeting & Exposition.

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What we found is that about a quarter of patients had detectable minimal residual disease [MRD] in their apheresis stem cell product, and those patients had much worse outcomes. The 5-year progression-free survival for that cohort of patients, the MRD-positive patients, was only 13% compared with 52% for MRD-negative patients. And as you would expect, the bad outcomes in those patients were driven by high rates of relapse after transplant. Those patients also had inferior progression-free survival. I think those results suggest that the quarter of patients or so who are MRD positive should receive an alternative treatment because they really don’t do well with autologous stem cell transplantation.

And then the other cohort that we analyzed was patients who had peripheral blood samples collected serially after transplant. And in that sample, we found that a positive MRD assessment in plasma with fairly high sensitivity and specificity could predict patients who were about to relapse with a median lead time of about 2 months. Again, I think one could think about using these data to support a clinical trial where patients have serial samples that have to be fairly frequent, serial samples collected after transplant, with the idea being that you might be able to preemptively treat some of these patients before they have clinical relapse.