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Exosomes as Liquid Biopsy Biomarkers in Diffuse Large B-cell Lymphoma (DLBCL)- Current State-of-the-Art and Unmet Clinical Needs
  • Kenneth Ofori,
  • Govind BhagatOrcid,
  • Alex Rai
Kenneth Ofori
Columbia University Irving Medical Center
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Govind Bhagat
Orcid
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Peer review status:IN REVISION

22 May 2020Submitted to British Journal of Clinical Pharmacology
25 May 2020Assigned to Editor
25 May 2020Submission Checks Completed
03 Jun 2020Reviewer(s) Assigned
09 Jul 2020Review(s) Completed, Editorial Evaluation Pending
02 Aug 2020Editorial Decision: Revise Minor

Abstract

Diffuse Large B-Cell Lymphoma is the most common type of Non-Hodgkin’s Lymphoma. The disease exhibits significant clinical and biologic heterogeneity. Treatment with standard first line therapy results in cure in about 60% of patients while 30-40%of patients either are refractory to therapy or relapse. Current prognostic scores and biomarkers are unable to accurately predict patients who would relapse or would have refractory disease. A part of the heterogeneity in the behavior of DLBCL is explained by the cell of origin of the tumor. Germinal center type (GCB) DLBCL which is derived from centroblasts are associated with better prognosis compared with activated B-cell type (ABC), which is derived from a B-cell committed to secretory differentiation. While the gold standard for cell of origin determination is gene expression profiling, immunohistochemical methods are routinely used because of more readily available fixed tissue and expertise. Immunohistochemical methods are however associated with a significant degree of discordance with GEP. Within the ABC and GCB types of DLBCL, subgroups of prognostic significance have been identified using various multiple approaches which do not inure themselves to routine practice partly because of limitation of diagnostic material or expertise. Exosomes are a class of membrane bound extracellular vesicles of endosomal origin, produced by multiple cell types. They are involved in intercellular communication and present in abundance in various bodily fluids. Exosomal cargo which includes nucleic acids and proteins can be analyzed, yielding diagnostic and prognostic information in management of DLBCL.