Researchers are using highly sensitive blood tests to better track lymphoma and predict who is most likely to stay in remission. These tests look for tiny amounts of tumor DNA in the blood, called circulating tumor DNA (ctDNA), to give an early signal of how well treatment is working.
How ctDNA is being used in lymphoma
In one real-world study, doctors followed 144 people with different types of lymphoma, including both fast-growing and slow-growing forms and patients receiving CAR T-cell therapy. The personalized Signatera test was used before treatment, during first-line therapy, at the end of treatment, and after CAR T-cell therapy to see if ctDNA could show treatment response and relapse risk. The test detected ctDNA in 94% of patients before treatment, and clearing ctDNA during therapy was strongly linked with better responses and outcomes. The ctDNA results were more powerful at predicting who would relapse than standard PET-CT scans, and combining ctDNA with imaging helped clarify which patients truly needed additional treatment.
These results suggest that end-of-treatment ctDNA testing could help avoid overtreatment for patients who are ctDNA-negative, even if their scans are uncertain, while flagging ctDNA-positive patients for closer monitoring or additional therapy. Researchers say ctDNA could become an important tool to personalize lymphoma care, guide treatment decisions, and design future trials that adjust therapy based on how quickly ctDNA clears.
What the HOVON study found
Another study, called HOVON, followed 166 people with diffuse large B-cell lymphoma over two years using a different ctDNA test called CLARITY. Early drops in ctDNA were associated with better outcomes, and patients who had a negative ctDNA test during follow-up had a very high chance of remaining relapse-free at 6 and 12 months. These results suggest ctDNA testing might help doctors decide when it is safe to ease off treatment or when to consider stronger therapy in future clinical trials.
Why this matters for patients
Together, these studies show that ctDNA blood tests may give a more precise picture of whether lymphoma treatment is working and how likely the disease is to come back. This could lead to more personalized care, where people doing well at the molecular level avoid unnecessary treatment and side effects, while those at higher risk are identified earlier for closer monitoring or new treatment options.
References
Galanina N, Iqbal M, Nousome D, et al. Real-world evaluation of ctdna for risk stratification across the spectrum of both aggressive and indolent lymphomas. Blood. 2025;146(suppl 1):281.
Wang S, et a. Prospective Validation of End-of-Treatment Circulating-Tumor DNA Measurable Residual Disease in First-Line Large B-cell Lymphoma Patients. Presented at the 2025 American Society of Hematology Meeting.
