Routine test may help find patients at high risk of developing blood cancer

By Pol Allingham via SWNS

A routine test may be able to detect patients at high risk of developing blood cancer, according to new research.

Blood samples - or liquid biopsies - could identify whether cancer patients face a higher risk of developing additional blood cancers.

It was already well-known that tumors shed DNA into the blood creating cell-free DNA (cfDNA).

Instead of invasive biopsies, blood samples are currently used to identify cfDNA which can allow doctors to better characterize cancers, select the best therapy, and monitor how the disease is progressing.

A condition called clonal haematopoiesis (CH) is commonly found in blood samples and paved the way for even more diagnostic possibilities.

Normally, haematopoietic stem cells create other blood cells from the bone marrow.

However, CH occurs when a haematopoietic stem cell starts creating stem cells with a different genetic pattern to normal blood cells.

The cells can then shed DNA into the blood and previous research shows there is a one percent chance CH will progress to blood cancer each year.

As a result, a team at Institut Gustave Roussy, in Villejuif, France, considered if the blood samples could be used to identify patients who have developed blood cancer or are likely to do so.

They tested the tests for myelodysplastic syndrome and acute myeloid leukaemia.

Myelodysplastic syndrome is a blood disorder originating in bone marrow, and it can develop into white blood cell cancer or acute myeloid leukaemia.

The researchers believed when a blood sample revealed high-risk CH doctors should study the blood to identify the likelihood it will become blood cancer, or whether it has already turned into blood cancer.

Consequently, they took blood samples from 1,416 patients with a range of solid tumors if they enrolled in the Gustave Roussy Cancer Profiling study (STING).

Dr. Marco Tagliamento, a research fellow at the Institut Gustave Roussy, France, said: “We found that 113 patients, or eight percent, had at least one clonal haematopoiesis mutation that could be considered to place them at higher risk of developing blood cancers during their life.

“Out of these patients, 45 were referred to our haematology unit by their oncologist and five were subsequently diagnosed with blood cancer: one with myelomonocytic leukaemia, two with myelodysplastic syndrome and two with essential thrombocythaemia.”

“Early detection could prevent complications during anti-cancer treatments, for instance alterations to blood counts, and consequent interruption or delay to treatment.

"It could also indicate possible diagnostic and therapeutic pathways for doctors to consider for haematological disease.”

The Gustave Roussy Molecular Tumour Board carefully selected each case for the study.

Dr Tagliamento said: “Case-by-case evaluation is crucial.

“Different aspects must be considered when evaluating the potential impact and management of high-risk clonal haematopoiesis in patients who already have cancer.

“These relate, for example, to the patients, their medical history and to the underlying cancers. All of them should be part of a balanced evaluation made for each individual case.

“We will continue to apply this approach within the Gustave Roussy Molecular Tumour Board. We want to implement and improve the algorithm's efficiency to select patients with solid cancers who could benefit from a haematological evaluation.

“These results are part of a team project led by Dr Mihaela Aldea and Dr Jean Baptiste Micol.”

The findings were presented at the 34th EORTC-NCI-AACR Symposium on Molecular Targets and Cancer Therapeutics in Barcelona, Spain.

Symposium chair Professor Ruth Plummmer, of Newcastle University, said: “This is well-conducted research that reveals an additional facet to the information gained from liquid biopsies.

“Dr Tagliamento is right to stress the importance of evaluating the context for each individual patient.

“Cancer patients have much to worry about, and so their doctors need to take into account the patient’s clinical situation and their treatment plan.

“Patients’ anxieties mean that it will not always be appropriate to highlight a potential increased risk of developing additional blood cancer in later years.

“Only some specific clonal haematopoiesis mutations are likely to predict a higher risk of blood cancer developing at some point in the future."

She added: “This study suggests patients with these mutations should be referred for further evaluation and even then, decisions about what would be best for these patients will depend on a range of other factors.”