Sriram Deepika, Lakhotia Rahul, Fenske Timothy S
Medical College of Wisconsin, Milwaukee, Wisconsin.
National Cancer Institute of the National Institutes of Health, Bethesda, Maryland.
Clin Adv Hematol Oncol. 2019 Sep;17(9):509-517.
In recent years, advances have been made in methods to assess response to therapy in lymphoma. Ideally, response assessment tools should be highly sensitive and specific for identifying a disease, should carry a minimal risk of harm to the patient, and should provide reproducible results. Traditional surveillance methods have included clinical assessment and, in many cases, routine surveillance imaging. Minimal residual disease (MRD) refers to the detection of disease level below that of these traditional surveillance methods. Either circulating tumor cells or their nucleic acid fragments released from necrotic/apoptotic cells can be measured in circulating peripheral blood, referred to as circulating tumor DNA (ctDNA). ctDNA can be detected with allele-specific polymerase chain reaction (ASO-PCR) or with next-generation sequencing (NGS) techniques. The use of ctDNA as a monitoring strategy in lymphoma can aid in assessment of disease burden, as well as prognostication, customization of therapy ("risk-adapted" strategies), monitoring for relapse, and consideration of early intervention ("preemptive" strategies), while reducing radiation exposure from surveillance imaging modalities that are presently used. In this review, we discuss the current state of the art in ctDNA measurement, as well as the clinical data supporting its potential utility in the management of lymphoma patients.
近年来，淋巴瘤治疗反应评估方法取得了进展。理想情况下，反应评估工具应具有高度敏感性和特异性以识别疾病，对患者造成的伤害风险应最小，并应提供可重复的结果。传统监测方法包括临床评估，在许多情况下还包括常规监测成像。微小残留病（MRD）是指检测到低于这些传统监测方法的疾病水平。循环肿瘤细胞或从坏死/凋亡细胞释放的核酸片段可在循环外周血中测量，称为循环肿瘤DNA（ctDNA）。ctDNA可通过等位基因特异性聚合酶链反应（ASO-PCR）或下一代测序（NGS）技术检测。将ctDNA用作淋巴瘤的监测策略有助于评估疾病负担、进行预后判断、定制治疗方案（“风险适应性”策略）、监测复发以及考虑早期干预（“先发制人”策略），同时减少目前使用的监测成像方式所带来的辐射暴露。在本综述中，我们讨论了ctDNA测量的当前技术水平，以及支持其在淋巴瘤患者管理中潜在效用的临床数据。
