Circulating Tumor DNA as Measurable Residual Disease in Aggressive B-Cell Lymphoma - CME - Guideline Central

CME

Title
Circulating Tumor DNA as Measurable Residual Disease in Aggressive B-Cell Lymphoma
Link
Description
Importance Achieving remission is the first step toward a cure in treating aggressive B-cell lymphomas. Radiographic imaging, such as fluorodeoxyglucose–positron emission tomography/computed tomography scans are the current standard to define remission at the end of therapy but lack specificity for lymphoma and cannot detect disease at the molecular level. Identifying measurable residual disease with ultrasensitive detection of circulating tumor DNA potentially offers the possibility of improving clinical outcomes.
Target Audience
Physicians
Learning Objectives
  • To identify the key insights or developments described in this article
Estimated Duration
60 minutes
Delivery Mode
Online
Format
Online Learning
Specialties
Oncology, Internal Medicine - General, Family Medicine, Critical Care, Primary Care
Professions
Physician
Keywords
B-Cell Lymphoma
Additional Information
Observations Early studies of circulating tumor DNA in aggressive B-cell lymphomas showed a strong association with overall tumor burden, and baseline quantitative levels are associated with clinical outcomes after frontline chemotherapy. Next-generation sequencing methods that detect lymphoma-relevant genetic aberrations in circulating tumor DNA can also be used for noninvasive genotyping that strongly mirror tissue biopsies. Rapid changes in circulating tumor DNA dynamics after 1 or 2 cycles of frontline chemotherapy or within weeks of treatment with chimeric antigen receptor T-cell salvage therapy are also highly prognostic. Although serial monitoring of circulating tumor DNA can detect molecular relapse 3 to 6 months before clinical relapse, improved analytical thresholds are required to detect measurable residual disease at a singular point at the end of therapy. Modern advances in circulating tumor DNA methods now allow for the reliable detection of measurable residual disease, with an analytical detection threshold of 1 in 1 million cell-free DNA molecules. Conclusions and Relevance The results of this review suggest that modern ultrasensitive methods of detecting circulating tumor DNA may improve the current definition of remission in aggressive B-cell lymphomas. Incorporating circulating tumor DNA at the end of therapy assessment identifies patients who do not require surveillance monitoring and introduces paradigms of treating measurable residual disease within clinical trials. Practical barriers, including standardization of collection, availability, turnaround times, and cost, remain hurdles preventing widespread implementation into clinical practice.
Disclosures and Disclaimers
CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accredited Providers
  • Accreditation Council for Continuing Medical Education
Activity Expiration Date
February 6, 2028
Credit Information
Credit TypeUnits / Unit TypeBoard
AMA PRA Category 1 Credit1 CreditsACCME- Accreditation Council for Continuing Medical Education
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