The prognostic value of clonal heterogeneity and quantitative assessment of plasma circulating clonal IG-VDJ sequences at diagnosis in patients with follicular lymphoma

// Clémentine Sarkozy 1, 2 , Sarah Huet 2, 3 , Victoria E.H. Carlton 4 , Bettina Fabiani 5 , Alain Delmer 6 , Fabrice Jardin 7 , Marie-Helene Delfau-Larue 8 , Maya Hacini 9 , Vincent Ribrag 10 , Stéphanie Guidez 11 , Malek Faham 4 , Gilles Salles 1, 2 1 Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service d’Hématologie, 69495 Pierre Bénite Cedex, France 2 NSERM1052, CNRS 5286, Université Claude Bernard, Faculté de Médecine Lyon-Sud Charles Mérieux Lyon-1, 69495 Pierre Bénite Cedex, France 3 Hospices Civils De Lyon, Laboratoire d’Hématologie, Pierre Bénite, France 4 Adaptive Biotechnologies Corp., South San Francisco, CA, USA 5 Assistance Publique – Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France 6 Service d’Hématologie, CHU de Reims, Reims, France 7 Centre Henri Becquerel, Service d’Hématologie, Rouen, France 8 Department of Biological Hematology and Immunology, Assistance Publique – Hôpitaux de Paris, Groupe Hospitalier Mondor, Créteil, France 9 Centre Hospitalier de Chambery, Service d’Hématologie, Chambery, France 10 Institut Gustave Roussy, Service d’Hématologie, Université Paris-Sacley, Villejuif, France 11 Service d’Hématologie, CHU de Poitiers, France Correspondence to: Gilles Salles, email: gilles.salles@chu-lyon.fr Keywords: follicular lymphoma, circulating tumor DNA, prognostic factor, rituximab, maintenance Received: December 02, 2016      Accepted: December 05, 2016      Published: January 02, 2017 ABSTRACT Recent advances in next-generation sequencing (NGS) have enabled the quantitation of circulating tumour DNA (ctDNA) encoding the clonal rearranged V(D)J immunoglobulin locus. We aimed to evaluate the clonal heterogeneity of follicular lymphoma (FL) in the tumour and the plasma at diagnosis and to assess the prognostic value of the ctDNA level. Plasma samples at diagnosis were available for 34 patients registered in the PRIMA trial (NCT00140582). One tumour clonotype or more could be detected for 29 (85%) and 25 (74%) patients, respectively, in the tumour or plasma samples. In 18 patients, several subclones were detected in the tumour (2 to 71 subclones/cases) and/or in the plasma (2 to 20 subclones/cases). In more than half of the cases, the distribution of subclones differed between the tumour and plasma samples, reflecting high clonal heterogeneity and diversity in lymphoma subclone dissemination. In multivariate analysis, a high level of ctDNA was the only independent factor associated with patients’ progression-free survival (HR 4, IC 95 (1.1-37), p=.039). In conclusion, an NGS-based immunosequencing method reveals the marked clonal heterogeneity of follicular lymphoma in patients with FL, and quantification of ctDNA at diagnosis represents a potential powerful prognostic biomarker that needs to be investigated in larger cohorts.