New Technique for Monitoring Lymphoma Relapse

About 80,000 people every year are diagnosed with lymphoma, an extremely rare type of blood cancer that begins in the immune system.

There are two types of lymphoma: Hodgkin disease and non-Hodgkin lymphoma, which originate in white blood cells. At Orlando Health, we often treat Diffuse large B-cell lymphoma (DLBCL), which affects seven out of 100,000 people every year. Fortunately, most patients who carry this diagnosis will do well with therapy. This prognosis is largely based on a determination of risk called an IPI score, with expectations of survival approaching 90 percent for people with low risk scores.

People who have this condition need to have follow-up care over time. This helps us monitor any signs of a potential relapse so that we can start treatment as early as possible. DLBCL can still be curable if there is a relapse, which is why it’s so important to have a reliable way to detect issues when they develop.

We’ve traditionally used CT scans to detect cancer recurrence, but a new method could help us detect a relapse of lymphoma with more accuracy.

The technique involves examining circulating tumor cells. Circulating tumor cells are microscopic cells that float around our bloodstream and may help to explain how and why cancers spread. The first reports of these cells dates back to the 1800s, but the potential use of them for treatment and prognosis remains unclear.

To detect these cells now, we must perform specialized DNA-based blood tests to help with detection. In a recent report, an analysis for circulating tumor cells allowed detection of recurrent lymphoma nearly three and a half months before radiology techniques were able to pick up on growth. This is encouraging news because CT scans, the method we’ve historically use, come with several issues.

First, regular CT scans are expensive. More importantly, each CT scan provides as much radiation as about 200 X-rays. CT scans also can be unreliable and may have findings that resemble lymphoma, when in fact everything is normal. And when looked at in large numbers, a CT scan was no more helpful than routine physical exams for detection of early relapse. For these reasons, we’ve begun to do fewer CT scans for routine detection.

To be clear, looking at circulating tumor cells is not currently the standard of care. If more research shows the effectiveness of this technique, it may provide an advantage for the detection of lymphoma relapse. This would give us a different and more reliable way to detect cancer recurrence and avoid unneeded radiation exposure, which is the best thing for patients long-term.