Table 3.

First applications of next-generation technologies to molecular monitoring in FL

StudyPatientsMarker/tissue/timingMethodPotential impact
Genuardi et al38  20 FL with no MBR or mcr BCL2/TLA
BM
At diagnosis and for MRD 
TLA BCL2/TLA in 8 (40%) of “marker-negative” cases
The new BCL2/TLA markers were suitable for RQ-PCR MRD analysis in 4 of 5 cases.
MRD by BCL2-TLA reached good sensitivity levels. 
Cavalli et al40  67 early stage FL BCL2/IGH
PB, BM
At diagnosis and for MRD 
ddPCR Concordance between ddPCR and RQ-PCR: 82%
ddPCR identified a MBR marker in 8 of 18 (44%) samples that resulted in MBR−/mcr− by qualitative nested PCR.
Molecular tumor burden at diagnosis ≥10−5 significantly predicted PFS only when quantified by ddPCR but not by RQ-PCR.
Higher sensitivity of ddPCR in RQ-PCR PNQ samples. 
Sarkozy et al42  34 FL from PRIMA trial IGH
Tumor biopsy
Plasma
At diagnosis 
NGS 29 (85%) had 1 or more tumor clonotypes in the tumor biopsy specimen.
25 (74%) had 1 or more tumor clonotypes in plasma.
18 of 24 (75%) patients with an IGH clonotype had several detectable subclones in the tumor or in the plasma.
13 of 24 (54%) showed a subclone detected in both the plasma and the tumor.
>50% of cases showed a different distribution of subclones between tumor and plasma.
High ctDNA levels at diagnosis predicted short PFS in MVA. 
Delfau-Larue et al43  FL PET TMTV (n = 133)
BCL2/IGH
PB CTC (n = 68)
PB cfDNA (n = 61)
At diagnosis 
ddPCR 23 of 68 cfDNA were BCL2/IGH+ (ctDNA ≤10% cfDNA).
High correlation between CTCs and TMTV and between cfDNA and TMTV
CTCs predictive of outcome in univariate analysis but not in MVA
Total cfDNA levels and TMTM are independent predictors of outcome. 
StudyPatientsMarker/tissue/timingMethodPotential impact
Genuardi et al38  20 FL with no MBR or mcr BCL2/TLA
BM
At diagnosis and for MRD 
TLA BCL2/TLA in 8 (40%) of “marker-negative” cases
The new BCL2/TLA markers were suitable for RQ-PCR MRD analysis in 4 of 5 cases.
MRD by BCL2-TLA reached good sensitivity levels. 
Cavalli et al40  67 early stage FL BCL2/IGH
PB, BM
At diagnosis and for MRD 
ddPCR Concordance between ddPCR and RQ-PCR: 82%
ddPCR identified a MBR marker in 8 of 18 (44%) samples that resulted in MBR−/mcr− by qualitative nested PCR.
Molecular tumor burden at diagnosis ≥10−5 significantly predicted PFS only when quantified by ddPCR but not by RQ-PCR.
Higher sensitivity of ddPCR in RQ-PCR PNQ samples. 
Sarkozy et al42  34 FL from PRIMA trial IGH
Tumor biopsy
Plasma
At diagnosis 
NGS 29 (85%) had 1 or more tumor clonotypes in the tumor biopsy specimen.
25 (74%) had 1 or more tumor clonotypes in plasma.
18 of 24 (75%) patients with an IGH clonotype had several detectable subclones in the tumor or in the plasma.
13 of 24 (54%) showed a subclone detected in both the plasma and the tumor.
>50% of cases showed a different distribution of subclones between tumor and plasma.
High ctDNA levels at diagnosis predicted short PFS in MVA. 
Delfau-Larue et al43  FL PET TMTV (n = 133)
BCL2/IGH
PB CTC (n = 68)
PB cfDNA (n = 61)
At diagnosis 
ddPCR 23 of 68 cfDNA were BCL2/IGH+ (ctDNA ≤10% cfDNA).
High correlation between CTCs and TMTV and between cfDNA and TMTV
CTCs predictive of outcome in univariate analysis but not in MVA
Total cfDNA levels and TMTM are independent predictors of outcome. 

CTC, circulating tumor cell; PNQ, positive not quantifiable; TMTV, total metabolic tumor volume.

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