ASH 2019 – follicular lymphoma: can minimal residual disease be a marker for relapse or cure?


  • Ben Gallarda
  • Univadis
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Takeaway

  • Assessment of minimal residual disease (MRD) status using next-generation sequencing (NGS) was likely to predict the risk for relapse or the probability of cure in patients with follicular lymphoma (FL) who were in remission for >2 years posttreatment.

Why this matters

  • Although FL is considered a treatable but noncurable condition, many patients have remained disease-free for several years following remission, leading to the belief that cure may be possible.

Study design

  • Study enrolled previously treated patients with FL who achieved remission and had no disease progression for >2 years after their last therapy.
  • MRD status (sensitivity level of 10−5) was determined using available biopsy specimens and peripheral blood at enrollment and subsequently every 6 months.
  • MRD was monitored using NGS-MRD assay which specifically tracks the clonality of FL.
  • Funding: None disclosed.

Key results

  • Dominant clones were identified in 43 patients, of which 38 (88%) were MRD negative at enrollment.
  • Of the 43 patients, 30 had been previously treated with 1 line of therapy, 6 with 2 lines, 6 with 3 lines, and 1 with 5 lines.
  • The median follow-up duration since the last line of therapy was 67 (range, 25-183) months.
  • By previous line of therapy:
    • 29 of 30 patients were MRD negative after first-line therapy;
    • 3 of 6 patients were MRD negative after second-line therapy;
    • 5 of 6 patients were MRD negative after third-line therapy;
    • 1 patient was MRD negative after fifth-line therapy.

Limitations

  • NGS-MRD assay may not be able to track all FL-associated clonotypes.

Expert commentary:

  • Dr Laurie Sehn, MD, MPH, medical oncologist at the University of British Columbia in Vancouver, Canada, said: “because CLL ‘floats in the blood’, it has been possible to use far simpler technology, such as flow cytometry. FL is a different disease from CLL and does not readily circulate in the blood. But with these newer technologies, we may be able to follow MRD in FL.”