{"entity":{"id":"ctdna-lymphoma-monitoring","kind":"technology","name":"ctDNA monitoring in lymphoma (PhasED-seq, clonoSEQ)","aka":[],"tldr":"A blood test that tracks lymphoma DNA far below what a PET scan can see, so doctors can tell early who is cured and who will relapse.","summary":"Phased variant enrichment and detection sequencing (PhasED-seq, Foresight CLARITY) detects lymphoma ctDNA to parts-per-million by tracking multiple mutations on the same DNA fragment. End-of-treatment undetectable ctDNA predicts cure in DLBCL better than PET in several cohorts; ctDNA-guided escalation and de-escalation trials are opening. clonoSEQ tracks the clonal immunoglobulin rearrangement.","status":"emerging","asOf":"2026-09-07","links":[{"label":"Kurtz et al., Circulating tumour DNA measurements as early outcome predictors in diffuse large B-cell lymphoma (Journal of Clinical Oncology 2018)","url":"https://doi.org/10.1200/JCO.2018.78.5246"},{"label":"Kurtz et al., Enhanced detection of minimal residual disease by targeted sequencing of phased variants (Nature Biotechnology 2021)","url":"https://doi.org/10.1038/s41587-021-00981-w"},{"label":"Scherer et al., Sci Transl Med 2016: ctDNA genotyping classifies cell of origin and tracks genome evolution in lymphoma (92 patients)","url":"https://doi.org/10.1126/scitranslmed.aai8545"},{"label":"Kurtz et al., Nat Biotechnol 2021: PhasED-seq, phased variants for residual disease detection in B-cell lymphoma (213 participants)","url":"https://doi.org/10.1038/s41587-021-00981-w"}],"tags":[],"related":[],"cancers":["dlbcl","hodgkin-lymphoma","non-hodgkin-lymphoma"],"sections":["diagnostics"],"technologies":["liquid-biopsy","mrd-testing"],"targets":[],"drugs":[],"companies":["foresight-diagnostics"],"institutions":[],"pathways":[],"terms":["mrd","ctdna"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":["paper-kurtz-j-clin-oncol","paper-kurtz-nat-biotechnol"],"journals":[],"dependsOn":[],"notes":["Lymphoma: the three jobs are genotyping, burden and residual disease. CAPP-Seq on 92 patients classified cell of origin from plasma and showed that ctDNA burden at diagnosis predicted outcome independently of clinical indices (Scherer 2016). PhasED-seq exploits the fact that lymphoma genomes carry many mutations close together, a consequence of somatic hypermutation, so several variants can be phased onto one DNA fragment; that pushes detection into the parts-per-million range and found residual disease in a further 25% of participants called negative by the earlier method after two cycles, who then did worse (Kurtz 2021). No approval depends on the result and no randomised trial has yet acted on it."],"principle":"Deep sequencing of plasma cell-free DNA for tumour-specific mutations or the clonal IG rearrangement, with error suppression via phased variants.","strengths":["Sensitivity below PET detection","Serial, non-invasive, interpretable in days"],"limitations":["Not yet a regulatory endpoint in DLBCL","Requires baseline tumour profile"],"since":2018},"route":"/technologies/ctdna-lymphoma-monitoring/","neighbours":{"cancer":[{"id":"advanced-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Advanced-stage classical Hodgkin lymphoma (stage III to IV)","route":"/cancers/advanced-stage-classical-hodgkin-lymphoma/"},{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"},{"id":"early-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Early-stage classical Hodgkin lymphoma (stage I to II)","route":"/cancers/early-stage-classical-hodgkin-lymphoma/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"},{"id":"non-hodgkin-lymphoma","kind":"cancer","name":"Non-Hodgkin lymphoma (all types)","route":"/cancers/non-hodgkin-lymphoma/"},{"id":"primary-mediastinal-b-cell-lymphoma","kind":"cancer","name":"Primary mediastinal (thymic) large B-cell lymphoma","route":"/cancers/primary-mediastinal-b-cell-lymphoma/"},{"id":"relapsed-refractory-hodgkin-lymphoma","kind":"cancer","name":"Relapsed and refractory classical Hodgkin lymphoma","route":"/cancers/relapsed-refractory-hodgkin-lymphoma/"}],"section":[{"id":"diagnostics","kind":"section","name":"Diagnostics & Biomarkers","route":"/fronts/diagnostics/"}],"technology":[{"id":"liquid-biopsy","kind":"technology","name":"Liquid biopsy (ctDNA)","route":"/technologies/liquid-biopsy/"},{"id":"mrd-testing","kind":"technology","name":"MRD / molecular residual disease testing","route":"/technologies/mrd-testing/"}],"company":[{"id":"foresight-diagnostics","kind":"company","name":"Foresight Diagnostics","route":"/companies/foresight-diagnostics/"}],"term":[{"id":"ctdna","kind":"term","name":"Circulating tumour DNA (ctDNA)","route":"/terms/ctdna/"},{"id":"mrd","kind":"term","name":"Minimal / molecular residual disease (MRD)","route":"/terms/mrd/"}],"paper":[{"id":"paper-kurtz-j-clin-oncol","kind":"paper","name":"Circulating Tumor DNA Measurements As Early Outcome Predictors in Diffuse Large B-Cell Lymphoma","route":"/key-papers/paper-kurtz-j-clin-oncol/"},{"id":"paper-kurtz-nat-biotechnol","kind":"paper","name":"Enhanced detection of minimal residual disease by targeted sequencing of phased variants in circulating tumor DNA","route":"/key-papers/paper-kurtz-nat-biotechnol/"}],"idea":[{"id":"idea-chemo-free-hodgkin","kind":"idea","name":"Chemotherapy-free Hodgkin lymphoma: brentuximab + PD-1 in early stage","route":"/ideas/idea-chemo-free-hodgkin/"},{"id":"idea-ctdna-guided-dlbcl-frontline","kind":"idea","name":"ctDNA-guided escalation and de-escalation in frontline DLBCL","route":"/ideas/idea-ctdna-guided-dlbcl-frontline/"}],"bottleneck":[{"id":"b-dormancy-mrd","kind":"bottleneck","name":"Dormant cells and minimal residual disease","route":"/bottlenecks/b-dormancy-mrd/"}],"biomarker":[{"id":"ctdna-mrd-positive","kind":"biomarker","name":"ctDNA MRD positivity (molecular residual disease after curative treatment)","route":"/biomarkers/ctdna-mrd-positive/"}]}}