A Tool for Predicting POD24 in Follicular Lymphoma?

 Very cool research from Spain, published in Clinical Cancer Research this week, in an article called "Monitoring of circulating tumor DNA predicts response to treatment and early progression in Follicular Lymphoma: results of a prospective pilot study." It has some potential implications for POD24 patients.

Lots of background before we get to the article.

POD24 stands for "Progression of Disease within 24 month." It's the name for what happens when an FL patient receives immunochemotherapy (like R-CHOP or B-R) and has a response, but then relapses (has progression of the disease) within 24 months. Research shows that this happens to about 20% of FL patients. Research also shows that, unfortunately, POD24 patients have a lower median 5 year survival rate than other FL patients. It was a fairly big deal that researchers were able to identify this group of patients, and lots of Lymphoma experts think that the Lymphoma Research Community needs to focus its attention on helping this group. And lots of researchers have done that.

Now, a separate bunch of researchers are working on "Liquid Biopsies." I'm sure we are all familiar in some way with "solid" biopsies, where a sample of possibly cancerous cells is taken from out body. Maybe this is with a fine needle aspiration (not fun, but the least painful option now available). For others -- me included -- this meant surgery to remove a lymph node, and/or a bone marrow biopsy to get inside a bone and remove some of the inner material. (I had both of those.) "Solid" biopsies are not fun. They are invasive and painful.

(Sorry -- I probably didn't need to remind you of that.)

With a liquid biopsy, a sample of blood is taken and analyzed to see if there are any tiny cancer cells floating around. They're called "circulating tumor DNA" or ctDNA because they float around in the blood, too small to be picked up a scan, and not gathered up in a lymph node in a big enough group to justify a solid biopsy. But they are still there, in very early stages. A "liquid biopsy" can find them, early, without all the cutting.

I wrote about liquid biopsies a few months ago, looking at an article that basically laid out what we knew about them so far, and how promising they were.

So bring those two things together now: some researchers in Spain have done a prospective study that uses liquid biopsies to find circulating tumor DNA to predict POD24. This is excellent news.

The researchers looked at samples of plasma (the liquid part of the blood) from 36 patients with Follicular Lymphoma. The patients came before, during, and after treatment (they had immunochemotherapy). Then they followed the patients for a median of about 3.5 years. The goal was to see which of the patients turned out to be POD24, and to then look at the plasma samples to see if there was any ctDNA in the samples, and whether that could have predicted the POD24.

What they found was that, yes indeed, the liquid biopsies could find the ctDNA and could predict that some patients would relapse early. There was a clear difference in the samples of POD24 patients and patients who did not have a Complete Response to treatment, compared to non-POD24 patients and those who did achieve a CR.

From this, they think their method for identifying ctDNA could be used during clinical trials to monitor patients, and could one day be used in clinical settings, allowing FL patients to monitor their status with a blood test, rather than a scan (or a solid biopsy).

Of course, the important words in the title are "prospective pilot study." This was a small sample of patients, not in an "official" trial setting. So it shows a lot of promise, but it's not something you're going to see in the doctor's office anytime soon.

I do think its important, though, to recognize that researchers are becoming more and more conscious of not only the importance of dealing with POD24, but also of just paying attention to Quality of Life for all of us.Liquid biopsies won't cure anything, but they will make the experience of living with FL a  little bit less unpleasant. And that's worth a lot.