Mayo Clinic recommends new routine testing for some non-Hodgkin lymphomas

Volume 3, Issue 4, 2014

Summary

Three recently discovered subgroups could change treatment recommendations.

Photograph of Andrew L Feldman, M.D.

Andrew L. Feldman, M.D.

A Mayo Clinic Cancer Center-led team of researchers has discovered three subgroups of a single type of non-Hodgkin lymphoma that have markedly different survival rates.

This discovery may call for a change in treatment approaches.

These subgroups could be differentiated only with the aid of novel genetic tests, which the research team recommends now giving to all patients with anaplastic lymphoma kinase-negative anaplastic large cell lymphoma (ALCL).

The team's study findings were published online in the June 3, 2014, issue of the journal Blood.

Patients whose lymphoma had a TP63 rearrangement had only a 17 percent chance of living five years beyond diagnosis, compared with 90 percent for patients whose tumors had DUSP22 rearrangements.

"This is the first study to demonstrate unequivocal genetic and clinical heterogeneity among systemic ALK-negative anaplastic large cell lymphomas," said Andrew L. Feldman, M.D., a Mayo Clinic Cancer Center pathologist, Damon Runyon Clinical Investigator and senior author of the multi-institutional study. "Most strikingly, patients with DUSP22-rearranged ALCL had excellent overall survival rates, while patients with TP63-rearranged ALCL had dismal outcomes and nearly always failed standard therapy."

Results from the study make a clear case for additional testing and possible changes to standard care, the researchers said. Currently, all ALK-negative anaplastic large cell lymphomas are treated the same, using chemotherapy and in some cases stem cell transplantation.

"This is a great example of where individualized medicine can make a difference," Dr. Feldman said. "Patients whose chance of surviving is 1 in 6 are receiving the same therapy as patients whose odds are 9 in 10. Developing tests that identify how tumors are different is a critical step toward being able to tailor therapy to each individual patient."

TP63 and DUSP22 rearrangements are examples of abnormal swapping of DNA that disturbs the way genes are arranged on a tumor cell's chromosomes.

These abnormalities cannot be seen in the standard microscopic evaluation that pathologists use to diagnose lymphoma, but they can be visualized using a genetic test called fluorescence in situ hybridization (FISH).

The authors of the study recommend performing FISH testing in all patients with ALK-negative anaplastic large cell lymphoma.

Watch a video of Dr. Feldman discussing this study.