Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
Division of Hematology and Oncology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, South Korea.
Ann Hematol. 2020 Jun;99(6):1293-1302. doi: 10.1007/s00277-020-04008-3. Epub 2020 Apr 15.
Cell-free DNA (cfDNA) can be released from tumor cells during proliferation and apoptosis; thus, a fraction of the cfDNA in patients with cancer is tumor-derived. However, the prognostic value of cfDNA in aggressive non-Hodgkin lymphoma (NHL) has not been determined. Between March 2017 and April 2019, plasma cfDNA was obtained from 158 patients with aggressive NHL who were registered in a prospective Samsung Medical Center lymphoma cohort (diffuse large B cell lymphoma (DLBCL), n = 51; T cell lymphoma (TCL), n = 51; NK/T cell lymphoma (NKTCL), n = 56). The concentration of cfDNA was estimated in longitudinal samples collected from patients with NHL before and during various chemotherapy regimens. In pretreatment samples, the median cfDNA concentration of all patients with aggressive lymphoma was 13.7 ng/dl (range 1.7-1792), which was significantly higher than that of healthy volunteers (median 7.4 ng, range 3.7-14.4, p < 0.001), and advanced stages showed a higher cfDNA level than earlier stages. Multivariate analysis identified high cfDNA as an independent factor for event-free survival that predicted poor prognosis in DLBCL (hazard ratio [HR] = 5.33, 95% confidence interval [CI] = 1.72-16.52, p = 0.003) and TCL (HR = 2.82, 95% CI = 1.10-7.20, p = 0.030). NKTCL patients with a high level of cfDNA had worse overall survival (HR = 4.71, 95% CI = 1.09-20.35, p = 0.037) compared with those with a low level of cfDNA. In this study, our results suggest the usefulness of pretreatment cfDNA as a prognostic marker for patients with DLBCL, TCL, and NKTCL.
循环游离 DNA（cfDNA）可在肿瘤细胞增殖和凋亡过程中从肿瘤细胞中释放出来；因此，癌症患者的 cfDNA 中有一部分是源自肿瘤的。然而，cfDNA 在侵袭性非霍奇金淋巴瘤（NHL）中的预后价值尚未确定。在 2017 年 3 月至 2019 年 4 月期间，从登记在三星医疗中心淋巴瘤队列中的 158 例侵袭性 NHL 患者中获得了血浆 cfDNA（弥漫性大 B 细胞淋巴瘤（DLBCL），n = 51；T 细胞淋巴瘤（TCL），n = 51；NK/T 细胞淋巴瘤（NKTCL），n = 56）。在接受各种化疗方案的 NHL 患者的纵向样本中估算了 cfDNA 的浓度。在预处理样本中，所有侵袭性淋巴瘤患者的 cfDNA 浓度中位数为 13.7ng/dl（范围 1.7-1792），明显高于健康志愿者（中位数 7.4ng，范围 3.7-14.4，p<0.001），晚期患者的 cfDNA 水平高于早期患者。多变量分析确定高 cfDNA 是无事件生存的独立因素，可预测 DLBCL（危险比[HR] = 5.33，95%置信区间[CI] = 1.72-16.52，p = 0.003）和 TCL（HR = 2.82，95%CI = 1.10-7.20，p = 0.030）的不良预后。cfDNA 水平较高的 NKTCL 患者的总生存时间更差（HR = 4.71，95%CI = 1.09-20.35，p = 0.037），而 cfDNA 水平较低的患者则相反。在这项研究中，我们的结果表明，预处理 cfDNA 可作为预测 DLBCL、TCL 和 NKTCL 患者预后的有用标志物。
