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Monitoring clinical outcomes in aggressive B-cell lymphoma: From imaging studies to circulating tumor DNA
Affiliation:1. Hospital Clínic of Barcelona and Institut d''Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer del Rosselló, 08036 Barcelona, Spain;2. Centre for Lymphoid Cancer, British Columbia Cancer Agency and the University of British Columbia, 600 West 10th avenue, Vancouver, BC V5Z 4E6, Canada;1. APHP, Saint-Louis Hospital, Hemato-Oncology, 4, Avenue Claude Vellefaux, 75010, Paris, France;2. Diderot University, Sorbonne Paris-Cité, Paris, France, 10 Avenue de Verdun, 75010, Paris, France;3. EA7324, Descartes University, 4 Avenue de l''Observatoire, 75006, Paris, France;4. APHP, Nuclear Medicine, Henri Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France;5. APHP, Pathology, Necker Hospital, 149 Rue de Sèvres, 75015, Paris, France;1. Servicio de Medicina Nuclear, Universidad Autónoma de Madrid, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain;2. Servicio de Medicina Interna, Universidad Autónoma de Madrid, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain;3. Unidad de Bioestadística, Instituto de Investigación Biomédica, Puerta de Hierro Segovia de Arana, CIBERESP, Madrid, Spain;4. Servicio de Anatomía Patológica, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain;5. Servicio de Hematología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain;1. Division of Oncology, Washington University Medical School, 660 South Euclid Avenue, Campus Box 8056, St Louis, MO, 63110, USA;2. Division of Medical Oncology, Department of Medicine, Washington University in St Louis School of Medicine, 660 South Euclid Avenue, Campus Box 8056, St Louis, MO, 63110, USA
Abstract:Recent guidelines have de-emphasized the role of routine surveillance computed tomography (CT) scans for diffuse large B-cell lymphoma (DLBCL) patients who achieve a complete response to front-line therapy. This shift in practice recommendations was prompted by retrospective studies that failed to demonstrate clear clinical utility for surveillance CT in unselected DLBCL patients. Controversy remains, however, over the role of routine surveillance CT in the highest risk patients for treatment failure who would remain candidates for aggressive salvage therapies. Novel high-throughput sequencing methods can non-invasively monitor tumor-specific DNA in the blood and offers clear advantages designed to overcome fundamental limitations of CT scans. This review will discuss the current controversies surrounding monitoring clinical outcomes in aggressive B-cell lymphomas, with a specific emphasis on DLBCL. Fundamental limitations of imaging scans will be addressed and the potential of monitoring circulating tumor DNA as an adjunct or replacement for CT scans will be discussed.
Keywords:Non-Hodgkin's lymphoma (NHL)  Interim monitoring  Minimal residual disease (MRD)  Surveillance monitoring  Computed tomography (CT)  Positron emission tomography (PET)  Circulating tumor DNA (ctDNA)
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