Advancing Lymphoma Care: ctDNA Applications in Risk Stratification and Treatment Monitoring

Dr. Megan Melody from Tampa General Hospital Cancer Institute and Dr. Mark Roschewski from Memorial Sloan Kettering Cancer Center discussed how circulating tumor DNA (ctDNA) testing is transforming lymphoma care through enhanced risk stratification, treatment monitoring, and personalized patient management. Key insights emphasized ctDNA as an emerging risk factor superior to baseline assessments, with most patients achieving undetectable levels after 2 cycles. Combined negative positron emission tomography and ctDNA results reduce relapse risk from 15% to 20% to single digits. However, ctDNA currently serves as a prognostic marker rather than treatment-guiding tool, with ongoing ALPHA3 trial investigating ctDNA-guided therapy using allogeneic CAR-T cells. Clinical Implementation: • Seventy-five percent concordance between ctDNA and PET imaging results • Serial testing preferred over single time-point assessments for surveillance • Technology varies across lymphoma subtypes, with phased variant assays showing superior sensitivity • Quantitative values enable kinetic monitoring for individual patients with baseline controls