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Enhancing Diagnosis in Chronic B-cell Lymphoproliferative Disorders Using Next-Generation Sequencing (ENABLE-NGS)

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ClinicalTrials.gov Identifier: NCT03344809
Recruitment Status : Unknown
Verified November 2017 by Royal Marsden NHS Foundation Trust.
Recruitment status was:  Recruiting
First Posted : November 17, 2017
Last Update Posted : November 17, 2017
Sponsor:
Information provided by (Responsible Party):
Royal Marsden NHS Foundation Trust

Brief Summary:
To enhance the diagnosis of unclassifiable, non-CLL B-LPDs using next-generation sequencing technology.

Condition or disease
Lymphoma

Detailed Description:

In recent years, next generation sequencing has revealed the genomic landscape of lymphoid disorders and identified mutations that have improved our understanding of their pathogenesis. It has also revealed new targets for drug development. While some of these mutations, such as the BRAF V600E mutation in Hairy Cell Leukaemia (HCL)2, are now accepted as disease defining mutations, others such as MYD88 and NOTCH1/2 mutations are found in more than one subtype of B-LPD3. The overlapping nature of some of these molecular aberrations could have important implications for treatment of these disorders as we move towards targeted therapy. EZH2 inhibitors, which are currently in early phase trials, are one such example of targeted therapy for B-LPDs based on mutations identified by next generation sequencing (NGS)4. The genetic makeup of these tumours is also likely to influence future classification systems.

At present, an integrated approach incorporating morphology and immunophenotyping remains integral to the classification of B-LPDs. The Haemato-oncology department at the Royal Marsden Hospital has an international reputation in the development of immunophenotyping as a tool for the diagnosis of lymphoproliferative disorders. For example, the CLL score developed by the Haemato-Oncology department continues to be used in several centres around the world for the diagnosis of CLL5. A similar score proposed for HCL by our Haemato-Oncology department is also widely used (6). On a service evaluation, we found 100% concordance between a HCL score of 4 and presence of the BRAF mutation in samples referred to us (unpublished data).

Our plan therefore is to systematically study unclassifiable groups of B-LPD by creating a well-defined immunomorphology work flow for their identification. Samples thus identified will be screened using a next-generation sequencing (NGS) panel which is able to detect well established, B-LPD associated translocations and genetic mutations.

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Study Type : Observational
Estimated Enrollment : 120 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: ENABLE-NGS: Enhancing Diagnosis in Chronic B-cell Lymphoproliferative Disorders Using Next-Generation Sequencing
Study Start Date : August 2016
Estimated Primary Completion Date : August 2018
Estimated Study Completion Date : July 2020

Resource links provided by the National Library of Medicine





Primary Outcome Measures :
  1. Proportion of cases where a definite category and/or detectable mutation can be identified. [ Time Frame: 2 years ]
    This will be reported as a percentage of the total number of cases sequenced


Secondary Outcome Measures :
  1. Demographics and distribution in each immunomorphological category [ Time Frame: 2 years ]
    Age and sex distribution will be reported along with the proportion of cases in each immunomorphologic category

  2. Correlation of each immunomorphological category with the mutation profile. [ Time Frame: 2 years ]
    The distribution of mutations within each immunomorphological category will be reported descriptively.


Biospecimen Retention:   Samples With DNA
  • 20mls of PB in EDTA
  • Further 20mls PB in EDTA in cases where the first sample does not yield adequate DNA.
  • 5ml of BM in EDTA (optional for patients not undergoing bone marrow as part of normal work-up.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population
Patients suffering with an unclassifiable B-cell lymphoproliferative disorder
Criteria

Inclusion Criteria:

  • Chronic, mature clonal B-cell malignancy that is not assignable to a specific WHO category by current technology (see flowchart in section below).

Exclusion Criteria:

  • Non-clonal B-cell proliferation.
  • High grade and/or immature clonal B-cell malignancy.
  • Bone marrow samples with less than 20% infiltration will be excluded
  • Samples from patients with a known classifiable chronic B-LPD based on lymph node biopsy for e.g. staging bone marrow samples on a patient with marginal zone lymphoma. If a definitive diagnosis is established on a subsequent lymph node biopsy, patient will remain on study and this will be correlated with NGS findings.
  • Patient unable to provide consent for tumour and germ line samples.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03344809


Contacts
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Contact: Sunil Iyengar 020 8642 6011 ext 2609 sunil.iyengar@rmh.nhs.uk

Locations
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United Kingdom
The Royal Marsden NHS Foundation Trust Recruiting
Sutton, Surrey, United Kingdom, SM2 5PT
Sponsors and Collaborators
Royal Marsden NHS Foundation Trust
Investigators
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Principal Investigator: Sunil Iyengar Royal Marsden NHS Foundation Trust
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Responsible Party: Royal Marsden NHS Foundation Trust
ClinicalTrials.gov Identifier: NCT03344809    
Other Study ID Numbers: CCR4383
First Posted: November 17, 2017    Key Record Dates
Last Update Posted: November 17, 2017
Last Verified: November 2017
Keywords provided by Royal Marsden NHS Foundation Trust:
lymphoma
unclassifiable
next
generation
sequencing
Additional relevant MeSH terms:
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Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases