Author ORCID Identifier
https://orcid.org/0000-0002-2446-004X
Date of Graduation
8-2022
Document Type
Thesis (MS)
Program Affiliation
Biomedical Sciences
Degree Name
Masters of Science (MS)
Advisor/Committee Chair
Michael Green
Committee Member
Robert Orlowski
Committee Member
Anirban Maitra
Committee Member
Michelle Hildebrandt
Committee Member
Michael Lorenz
Committee Member
Hans Lee
Abstract
Multiple myeloma (MM) is an incurable plasma cell dyscrasia. Recent advances in MM therapy, including CAR-T therapy, have increased survival and shown the value of assessing treatment response with great sensitivity, both in acute and long-term settings. Cell-free DNA, DNA fragments which are released into circulation as a part of normal cellular turnover, is a useful and dynamic biomarker in cancer patients due to the presence of circulating tumor DNA (ctDNA), which is readily identified using next generation sequencing. Here we report the analytical sensitivity, applicability, consistency, and prognostic ability of M5Seq, a novel hybrid capture panel designed for MM ctDNA. We performed in-silico validation of this panel and found high applicability (1,173/1,212 tumors with ≥1 variant covered, 97%, mode 6 variants covered). By sequencing serial dilutions of simulated cancer DNA in healthy donor DNA, we observed a limit of analytical sensitivity at 5x10-5 and a limit of linearity at 10-4. Then, we applied this method to the matched pre-treatment tumor and plasma samples of 10 newly diagnosed MM patients. We observed moderate concordance in the mutations detected in each compartment, consistent with existing literature. Based off these data, we applied M5Seq to plasma samples from 18 patients undergoing anti-BCMA chimeric antigen receptor T cell therapy (CAR-T). We observed similar concordance in the CAR-T cohort as in the newly diagnosed patients. In 14 evaluable patients, we observed no statistically significant decreases in variant allele fraction within two days of CAR-T infusion between patients achieving a complete response or better within 30 days of infusion as determined by IMWG criteria, as compared to those patients with stable or progressing disease. Furthermore, while we observed a slight overall survival advantage in patients with decreased VAF from baseline, this association did not meet the threshold for statistical significance.
Keywords
Multiple myeloma, CAR-T, MRD, kinetics, tumor burden, concordance, relapse
Included in
Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons, Diseases Commons, Medical Sciences Commons, Medical Specialties Commons, Translational Medical Research Commons