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Navrkalova V, Mareckova A, Hricko S, Hrabcakova V, Radova L, Kubes V, Porc J, Reigl T, Pospisilova S, Kotaskova J, Janikova A. Reliable detection of CNS lymphoma-derived circulating tumor DNA in cerebrospinal fluid using multi-biomarker NGS profiling: insights from a real-world study. Biomark Res 2025; 13:71. [PMID: 40346678 PMCID: PMC12065147 DOI: 10.1186/s40364-025-00777-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Accepted: 04/13/2025] [Indexed: 05/11/2025] Open
Abstract
BACKGROUND Diagnosing primary or secondary CNS lymphoma (CNSL) is a clinical challenge due to the limitations of standard biopsy and imaging procedures despite established guidelines. Therefore, accurate biomarkers and analytical methods that are convenient for practical routine use are needed to diagnose and manage these aggressive lymphomas effectively. We evaluated the utility of minimally invasive circulating tumor DNA (ctDNA) detection in a prospective real-world scenario, moving this approach closer to clinical practice. METHODS A total of 164 plasma, cerebrospinal fluid (CSF), and tumor samples from 56 CNSL patients were collected to analyze tumor DNA by the diagnostic next-generation sequencing (NGS) panel LYNX, enabling simultaneous analysis of gene variants, chromosomal aberrations, and antigen receptor rearrangements in targeted regions. RESULTS The well-known genetic heterogeneity of CNSL was refined with integrative molecular data, showing the most frequent MYD88, PIM1, and KMT2D mutations and a broad spectrum of chromosomal aberrations, reflecting high genomic complexity. The multi-target approach achieved a substantially higher detection rate of CNS infiltration (90%) than tracking a single variant in gene MYD88 (46%). CSF clearly surpasses plasma if applying a routine (non-ultrasensitive) NGS approach and allows for more reliable evidence of CNS involvement than conventional flow cytometry (91% vs. 21%, p < 0.001). Parallel analysis of tumor DNA in both cell-free and cellular DNA from CSF makes the probability of primary or secondary CNS malignancy detection even higher. CONCLUSIONS Our prospective, tissue-agnostic approach highlights the feasibility of ctDNA sequencing by a commonplace and affordable method, offering higher sensitivity to detect CNS infiltration with lymphoma than standard cell-analyzing techniques. We accentuate the benefit of a multi-target NGS approach and adequate CSF sampling to obtain satisfactory diagnostic yield. Less invasive liquid biopsy testing by comprehensive NGS complements standard procedures in the diagnostics and management of CNSL patients, especially when encountering limitations.
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Affiliation(s)
- Veronika Navrkalova
- Department of Internal Medicine- Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
- Center of Molecular Medicine, CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech Republic.
- Department of Medical Genetics and Genomics, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czech Republic.
| | - Andrea Mareckova
- Department of Internal Medicine- Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Samuel Hricko
- Department of Internal Medicine- Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Viera Hrabcakova
- Department of Internal Medicine- Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lenka Radova
- Center of Molecular Medicine, CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech Republic
- Department of Medical Genetics and Genomics, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Vaclav Kubes
- Department of Pathology, University Hospital Brno, Brno, Czech Republic
| | - Jakub Porc
- Center of Molecular Medicine, CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Tomas Reigl
- Center of Molecular Medicine, CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Sarka Pospisilova
- Department of Internal Medicine- Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Center of Molecular Medicine, CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech Republic
- Department of Medical Genetics and Genomics, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Jana Kotaskova
- Department of Internal Medicine- Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Center of Molecular Medicine, CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech Republic
- Department of Medical Genetics and Genomics, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Andrea Janikova
- Department of Internal Medicine- Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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Toader C, Dumitru AV, Radoi MP, Glavan LA, Ilie MM, Covache-Busuioc RA, Buica V, Corlatescu AD, Costin HP, Crivoi C, Ciurea AV. Surgical Considerations in Treating Central Nervous System Lymphomas: A Case Series of 11 Patients. Curr Oncol 2024; 31:6659-6672. [PMID: 39590122 PMCID: PMC11592470 DOI: 10.3390/curroncol31110491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 10/07/2024] [Accepted: 10/18/2024] [Indexed: 11/28/2024] Open
Abstract
In this retrospective unicentric study, we analyzed the medical records of 11 patients who were surgically treated for CNS lymphoma, both primary and secondary, between 2009 and 2024. Given the rarity of CNS lymphomas and their diverse signs and symptoms based on tumoral location, our aim was to describe key aspects, such as clinical presentations and surgical management. A possible relationship between obesity and CNS lymphoma progression was investigated through an analysis of previous study findings. The literature suggests a wide spectrum of manifestations, from nausea and headaches to loss of equilibrium and speech impairment. A predominance of unsystematized balance disorders and epileptic seizures were affirmed. Notably, as emerged from our study, aphasia was a particularly interesting neurological symptom due to its rarity in the clinical features of CNSL. Other significant factors, such as tumor localization and perioperative phases, were thoroughly investigated, with the latter highlighted by an illustrative case report. Additionally, a literature review was included, comprising nine recent retrospective studies on the efficacy of surgical resection for patients diagnosed with PCNSL.
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Affiliation(s)
- Corneliu Toader
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (L.-A.G.); (M.-M.I.); (R.-A.C.-B.); (V.B.); (A.-D.C.); (H.-P.C.); (A.V.C.)
- Department of Vascular Neurosurgery, National Institute of Neurovascular Disease, 077160 Bucharest, Romania
| | - Adrian Vasile Dumitru
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (L.-A.G.); (M.-M.I.); (R.-A.C.-B.); (V.B.); (A.-D.C.); (H.-P.C.); (A.V.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Mugurel Petrinel Radoi
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (L.-A.G.); (M.-M.I.); (R.-A.C.-B.); (V.B.); (A.-D.C.); (H.-P.C.); (A.V.C.)
- Department of Vascular Neurosurgery, National Institute of Neurovascular Disease, 077160 Bucharest, Romania
| | - Luca-Andrei Glavan
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (L.-A.G.); (M.-M.I.); (R.-A.C.-B.); (V.B.); (A.-D.C.); (H.-P.C.); (A.V.C.)
| | - Milena-Monica Ilie
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (L.-A.G.); (M.-M.I.); (R.-A.C.-B.); (V.B.); (A.-D.C.); (H.-P.C.); (A.V.C.)
| | - Razvan-Adrian Covache-Busuioc
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (L.-A.G.); (M.-M.I.); (R.-A.C.-B.); (V.B.); (A.-D.C.); (H.-P.C.); (A.V.C.)
| | - Vlad Buica
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (L.-A.G.); (M.-M.I.); (R.-A.C.-B.); (V.B.); (A.-D.C.); (H.-P.C.); (A.V.C.)
| | - Antonio-Daniel Corlatescu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (L.-A.G.); (M.-M.I.); (R.-A.C.-B.); (V.B.); (A.-D.C.); (H.-P.C.); (A.V.C.)
| | - Horia-Petre Costin
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (L.-A.G.); (M.-M.I.); (R.-A.C.-B.); (V.B.); (A.-D.C.); (H.-P.C.); (A.V.C.)
| | - Carla Crivoi
- Department of Computer Science, Faculty of Mathematics and Computer Science, University of Bucharest, 010014 Bucharest, Romania;
| | - Alexandru Vlad Ciurea
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (L.-A.G.); (M.-M.I.); (R.-A.C.-B.); (V.B.); (A.-D.C.); (H.-P.C.); (A.V.C.)
- Neurosurgery Department and Scientific, Sanador Clinical Hospital, 010991 Bucharest, Romania
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Smith SM, Pasqualucci L. Introduction to series: Diffuse large B-cell lymphoma. Semin Hematol 2023; 60:251-254. [PMID: 38326145 DOI: 10.1053/j.seminhematol.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Affiliation(s)
- Sonali M Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, IL.
| | - Laura Pasqualucci
- Institute for Cancer Genetics, Department of Pathology and Cell Biology, and the Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
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