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Blood, 15 August 2001, Vol. 98, No. 4, pp. 940-944
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Lack of correlation between numbers of circulating
t(14;18)-positive cells and response to first-line treatment in
follicular lymphoma
Caroline M. P. W. Mandigers,
Jules P. P. Meijerink,
Ewald J. B. M. Mensink,
Evelyn L. R. T. M. Tönnissen,
Konnie M. Hebeda,
M. José J. T. Bogman, and
John M. M. Raemaekers for the Interzol (South-East
Netherlands Comprehensive Cancer Centers Cooperative
Group)
From the Departments of Hematology and Pathology and
the Central Hematology Laboratory, University Medical Center Nijmegen,
The Netherlands.
In follicular lymphoma, the t(14;18) status of the peripheral blood
and bone marrow analyzed by polymerase chain reaction (PCR) is assumed
to correlate with disease activity in patients with relapsed disease.
The clinical significance of quantitating circulating lymphoma cells by
real-time PCR is reported in patients on first-line treatment.
Thirty-four consecutive patients with previously untreated follicular
lymphoma and detectable t(14;18)-positive cells in pretreatment
peripheral blood samples were monitored. All patients were treated with
standard chemotherapy in combination with interferon alfa-2b. Before
and after induction therapy, blood samples were taken for quantitative
analysis of t(14;18). At presentation, a median of 262 t(14;18)-positive cells per 75 000 normal cells was found (range,
1-75 000). Patients with lower numbers of circulating tumor cells more
frequently had bulky disease (P = .02). Seventy-nine percent of the patients responded clinically to treatment. In 22 of 28 patients, including 4 patients in whom treatment had failed clinically,
the number of circulating t(14;18)-positive cells decreased to
undetectable or low levels after therapy. In the remaining responding
patients, circulating tumor cells persisted after therapy. These
quantitative data on circulating t(14;18)-positive cells call into
question the usefulness of molecular monitoring of the blood in a group
of patients with follicular lymphoma uniformly treated with a
noncurative first-line regimen. T(14;18)-positive cells decreased in
peripheral blood after treatment, irrespective of the clinical
response. Therefore, the significance of so-called molecular remission
should be reconsidered in follicular lymphoma.
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