Dr Danilov on Using MRD Status to Predict Outcomes in Hematologic Malignancies

Alexey Danilov, MD, PhD, hematologist/oncologist, associate director, Toni Stephenson Lymphoma Center, professor, Division of Leukemia, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, discusses findings from a study evaluating the feasibility of using minimal residual disease (MRD) status to predict treatment outcomes in patients with follicular lymphoma (FL) previously treated with chemoimmunotherapy.

Findings from this investigation, which evaluated patients from the phase 3 SWOG S0016 clinical trial (NCT00006721), were shared at the 2023ASH Annual Meeting. Danilov begins by stating that the evaluation of MRD is a prominent focus in lymphoma research. Although flow cytometry–based assays have been extensively used in chronic lymphocytic leukemia (CLL), they prove less informative in non-Hodgkin lymphoma, where a circulating clone may not be present in the blood or bone marrow, he explains. Molecular assays, particularly the adaptive clonal assay, have been applied in CLL and mantle cell lymphoma, he elucidates. However, for FL, the suitability, predictiveness, and feasibility of such molecular assays remain unexplored, Danilov implores.

This study is pioneering an effort to address these questions, he expands. Investigators evaluated samples from the randomized SWOG S0016 study, which compared CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) with rituximab (Rituxan) plus CHOP (R-CHOP) in patients with de novo FL. In this study, investigators performed high sequencing of immunoglobulin heavy and light chain loci through clonal assays, Danilov emphasizes. Tumor biopsies taken before treatment and subsequent 1-year bone marrow biopsy specimens were screened for residual disease, establishing patients’ MRD status, he explains.

For the first time, investigators presented evidence that achieving an undetectable MRD status, evaluated through ClonoSeq, is indicative of enhanced 5- and 10-year PFS in patients with FL who received initial chemoimmunotherapy. Conversely, MRD-positive status in the bone marrow after 1 year correlated with a higher risk of progression or death within 24 months, Danilov concludes.