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Blood cancer cells taken from a patient's blood or marrow are exposed within days to a panel of approved drugs, and the ones that kill the cancer cells while sparing healthy ones are offered back to the patient; a Vienna trial found this beat the previous treatment in more than half of heavily treated patients.
What it measures. Leukaemia and lymphoma cells survive a few days outside the body, long enough to test a hundred or more approved drugs directly on them. Two laboratory approaches dominate: viability screening of purified cells in 384-well plates, developed at the Institute for Molecular Medicine Finland (FIMM) in Helsinki as drug sensitivity and resistance testing, and image-based single-cell screening (pharmacoscopy) at CeMM in Vienna, which reads how each drug shifts the ratio of malignant to normal cells in a mixed sample so the result reflects selective killing. The readout is a ranked list of drugs the patient's own cells respond to.
Evidence. In the Vienna EXALT trial (Cancer Discovery 2022), 56 patients with relapsed aggressive blood cancers were treated on the basis of image-based screening; 54 per cent had a progression-free survival at least 1.3 times longer than on their previous line of therapy, and a group of exceptional responders emerged. The Helsinki group runs a functional precision medicine tumour board for acute myeloid leukaemia and reported similar feasibility. Randomised trials comparing functional selection with standard choice are underway.
Who should have it and what changes. Today this is offered inside trials and at a few academic centres for patients with relapsed or refractory leukaemia, lymphoma or myeloma who have exhausted standard options. A positive screen points to a repurposed or off-label drug that the treating team may use; a negative screen argues for a trial of something new. Turnaround is under a week, faster than organoid testing for solid tumours, and the cost is that of a specialised laboratory assay. No screening platform of this kind is regulator-cleared as a diagnostic.
Fresh malignant cells from blood or marrow are plated against a library of approved and investigational drugs; viability or high-content single-cell imaging quantifies selective killing of malignant versus normal cells within days.
Query for this technology: (TITLE:"Ex vivo drug sensitivity screening in blood cancers" OR ABSTRACT:"Ex vivo drug sensitivity screening in blood cancers" OR TITLE:"EXALT" OR ABSTRACT:"EXALT" OR TITLE:"drug sensitivity and resistance testing" OR ABSTRACT:"drug sensitivity and resistance testing" OR TITLE:"DSRT" OR ABSTRACT:"DSRT") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Ex vivo drug sensitivity screening in blood cancers (EXALT), not a curated reading list.
Shares BH3 profiling (functional apoptosis testing), Functional (ex vivo) drug testing, Venetoclax, Chronic lymphocytic leukaemia.
Shares Hold organoid drug tests to the same standard as a diagnostic test, Organoid-guided therapy at scale, Functional (ex vivo) drug testing, Patient-derived organoids.
Shares Hold organoid drug tests to the same standard as a diagnostic test, Organoid-guided therapy at scale, Functional (ex vivo) drug testing, Patient-derived organoids.
Shares BCL-2 inhibitors, Azacitidine, Venetoclax, Myelodysplastic syndromes / neoplasms (MDS).
Shares Myelodysplastic syndromes / neoplasms (MDS), Chronic lymphocytic leukaemia, Acute lymphoblastic leukaemia, Acute myeloid leukaemia.
Shares BCL-2 inhibitors, Venetoclax, Chronic lymphocytic leukaemia, Acute myeloid leukaemia.
Shares Myelodysplastic syndromes / neoplasms (MDS), Chronic lymphocytic leukaemia, Acute lymphoblastic leukaemia, Acute myeloid leukaemia.
Shares Myelodysplastic syndromes / neoplasms (MDS), Chronic lymphocytic leukaemia, Acute lymphoblastic leukaemia, Acute myeloid leukaemia.