The purpose of the Oxford Pre-Cancerous Lymphoproliferative Disorders: Analysis and Interception study (OxPLoreD) is to learn more about people with early stage lymphoproliferative disorders. These are conditions where the immune system is not entirely normal and may produce abnormal lymphocytes (a type of white blood cell) or proteins in the blood. The majority of individuals with lymphoproliferative abnormalities do not experience any serious effect on their health, however a small number do go on to develop more serious conditions, such as blood or bone marrow cancers. Out of a hundred people with the pre-cancerous lymphoproliferative disorders, only one or two per year will go on to develop blood or bone marrow cancer. Currently, we do not have a reliable way to predict which individuals with these disorders are more likely to develop a blood or bone marrow cancer. The OMDC is leading this study into the identification of novel biomarkers in liquid biopsies to predict disease progression.
The Oxford Suspected Cancer (SCAN) Pathway aims to reduce the time that patients who have vague symptoms that could be cancer wait to be diagnosed. The aim is to increase the number of patients that are diagnosed at an early stage in their illness. With faster and earlier diagnosis improving the patients experience of being diagnosed. The pathway involves GPs in Oxfordshire referring all patients aged 40 and over with vague symptoms to the SCAN Pathway if the GP thinks there is a chance they have cancer. These patients will quickly be given blood tests, a stool test, and a CT scan. The OMDC is supporting this study by co-ordinating the bio-banking and analysis of liquid biopsies from these patients.
The OMDC are the lead academic and sample processing laboratory for STELLAR, a phase II trial of patients with newly diagnosed or relapsed Richter’s syndrome. Transformation of chronic lymphocytic leukaemia (CLL) to diffuse large B-cell lymphoma (DLCBL) type Richter’s syndrome (RS) carries a dismal prognosis. Standard-of-care chemoimmunotherapy for de novo RS is inadequate with median survival of less than one year. Patients are frequently elderly or have co-morbidities limiting dose-intense chemotherapy. Treatment of relapsed/refractory (R/R) RS and RS emerging after CLL-directed therapy represent urgent unmet clinical needs. Agents targeting Bruton’s tyrosine kinase (BTK) deliver improved outcomes for patients with high-risk CLL and expand effective treatments to frailer patients. Acalabrutinib is an oral, second-generation BTK inhibitor with a favourable toxicity profile and demonstrated activity in CLL and B-cell lymphomas. Combination of acalabrutinib with standard-of-care CHOP-R chemoimmunotherapy offers a sound rationale to test in a prospective trial for de novo RS.