Detection and Prognostic Value of Recurrent XPO1 Mutations of Patients With Classical Hodgkin Lymphoma (XPO1)

Prevalence, Kinetic and Prognostic Value of XPO1 E571K Mutation Detection in Plasma Cell-free DNA From Patients Xith Classical Hodgkin Lymphoma

The purpose of this study is to determine if the XPO1 E571K mutation could be used as molecular residual disease biomarker in classical Hodgkin's lymphoma. To determine the interest of the mutation assessment by digital Polymerase Chain Reaction, sensitivity and specificity after 2 courses of chemotherapy (C2) will be compared with the deltaSUVmax determined by Positron Emission Tomography after C2 and at end of treatment.

Study Overview

• Status: Unknown
• Conditions: Classical Hodgkin Lymphoma
• Intervention / Treatment: Other: Digital Polymerase Chain Reaction

Detailed Description

A research team of Centre Henri Becquerel recently detected an unexpected recurrent point mutation of XPO1 (exportin 1) (also known as Chromosome Region Maintenance 1) located in exon 15 (c.1711G>A) leading to the Glu571Lys (p.E571K) missense substitution in relapsed/refractory (R/R) Primary Mediastinal Large B-cell Lymphoma (PMBL) patients included in the LYSA LNH03 trial program and in classical Hodgkin's Lymphoma patients. It was found recurrent XPO1 E571K mutations in a large cohort of 94 patients with classical Hodgkin's lymphoma. This observation is new and could add new information on driver events and tumorigenesis in this disease. In total, 24.2 % of the patients with classical Hodgkin's lymphoma harbored the XPO1 E571K mutation. It is remarkable that 29% of all XPO1 mutations were only found in the plasma but not in the tumor because of the well-known tumor cell sparsity in Hodgkin's lymphoma. In this particular disease, highly sensitive techniques like digital Polymerase Chain Reaction and targeted Next-Generation Sequencing are essential to highlight low frequency mutations. The research team of the Centre Henri Becquerel have identified a trend toward unfavorable prognostic impact in terms of progression-free survival in patients with detectable XPO1 E571K mutation in plasma cell-free DNA at the end of treatment, which could prove to be statistically significant in a larger cohort. It was observed that 57% of patients who ultimately relapsed were positive in the plasma after end of therapy. It remains to be established whether this mutation adds new relevant value as compared to Positron Emission Tomography-scan.

• Study Type: Interventional
• Enrollment (Anticipated): 130
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Fabrice JARDIN, PUPH; Phone Number: +33232082465; Email: fabrice.jardin@chb.unicancer.fr

Study Locations

• France
  • Rouen, France, 76000
    • Recruiting
    • Centre Henri Becquerel
    • Contact: Fabrice JARDIN, PUPH; Phone Number: +33232082465; Email: fabrice.jardin@chb.unicancer.fr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Age ≥18 years
• Pathologically confirmed, recent diagnosis of classical Hodgkin Lymphoma
• treatment planned with Adriamycin Bleamycin Vinblastine Dacarbazine (ABVD) or Bleomycin Etoposide Adriamycin Cyclophosphamide Vincristine Procarbazine Prednisone (BEACOPP) regimen (and radiotherapy if applicable)
• all stages (Ann Arbor I - IV)
• Written informed consent
• Patient affiliated or beneficiary of a benefit system
• untreated patient (no corticosteroids or chemotherapy)

Exclusion Criteria:

• No informed consent
• Treatment by ABVD or BEACOPP not indicated
• Previously treated Hodgkin lymphoma (including corticosteroids)
• Patients who are pregnant or lactating
• Active Hepatitis B or Hepatitis C infection
• Known human immunodeficiency virus (HIV) infection - Patient with no social protection
• Patient under tutorship or curatorship
• Patient not affiliated of beneficiary of a benefit system
• Medical contraindication to PET/CT

Study Plan

How is the study designed?

Design Details

• Primary Purpose: OTHER
• Allocation: NA
• Interventional Model: SINGLE_GROUP
• Masking: NONE

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
OTHER: XPO1 E571K mutation detection; Determination of mutation of XPO1571K in patient with classical hodgkin Lymphoma by digital PCR on blood samples and biopsy	Other: Digital Polymerase Chain Reaction; Determination of mutation of XPO1 E571K by digital PCR in blod sample of patient with classical hodgkin lymphoma

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
If the mutation can be used as a molecular minimal residual disease biomarker	Comparison of the sensitivity and specificity of the detection of the mutation between delta Standard Uptake Value max (SUV max) determined by PET after two courses of chemotherapy	56 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Kinetic of allele frequency decrease	difference between the variant allele fraction at the end of treatment and at the diagnosis	224 days
Variation of Deauville scale	Difference of metabolic parameter in TEP between the end of treatment and the diagnosis	224 days
Progression-free survival	Time between the inclusion and the date of progression or death	2 years

Collaborators and Investigators

• Sponsor: Centre Henri Becquerel
• Investigators: Principal Investigator: Fabrice JARDIN, PUPH, Centre Henri Becquerel

Publications and helpful links

General Publications

• Camus V, Viennot M, Lequesne J, Viailly PJ, Bohers E, Bessi L, Marcq B, Etancelin P, Dubois S, Picquenot JM, Veresezan EL, Cornic M, Burel L, Loret J, Becker S, Decazes P, Lenain P, Lepretre S, Lemasle E, Lanic H, Menard AL, Contentin N, Tilly H, Stamatoullas A, Jardin F. Targeted genotyping of circulating tumor DNA for classical Hodgkin lymphoma monitoring: a prospective study. Haematologica. 2021 Jan 1;106(1):154-162. doi: 10.3324/haematol.2019.237719.

Study record dates

Study Major Dates

• Study Start (ACTUAL): June 1, 2016
• Primary Completion (ANTICIPATED): December 1, 2018
• Study Completion (ANTICIPATED): June 1, 2020

Study Registration Dates

• First Submitted: June 13, 2016
• First Submitted That Met QC Criteria: June 23, 2016
• First Posted (ESTIMATE): June 28, 2016

Study Record Updates

• Last Update Posted (ACTUAL): July 23, 2018
• Last Update Submitted That Met QC Criteria: July 20, 2018
• Last Verified: July 1, 2018

More Information

Terms related to this study

• Keywords: mutation; Digital PCR; Hodgkin Lymphoma; classical
• Additional Relevant MeSH Terms: Immune System Diseases; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Lymphatic Diseases; Immunoproliferative Disorders; Lymphoma; Hodgkin Disease
• Other Study ID Numbers: CHB 16.02

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO