ClonoSEQ
by NIKHIL ATHREYA
Simple yet effective, Adaptive Biotechnologies’ ClonoSEQ process to detect minimal residue disease( MRD) is leading the way to prevent relapse from lymphatic cancer.
Over the forty years that oncologists have studied the natures of various cancers, one common obstacle has eluded them: the risk of relapse, which is scientifically referred to as MRD, or minimal residual disease. Relapse occurs when a few lymphatic cancer cells survive cancer treatment like radiation or chemotherapy and spread to other parts of the body to begin the process of cancer growth in those regions. What is especially troubling is that the malignant cells that cause relapse are often too miniscule for MRD detection methods, preventing any potential identification of cancer cells. However, after four decades, scientists are now capable of discerning these diminutive cells through a procedure known as ClonoSEQ.
To address this situation, scientists primarily utilized one main MRD-detection method: flow cytometry. Flow cytometry involves staining cells with a myriad of antibodies containing fluorescent tags. These antibodies then search and attach themselves to the cancerous cell, allowing lasers to detect the fluorescent tags and determine the number of latent malignant cells. However, this process only finds one cancerous cell out of 10,000 normal cells( normal cells account for all of the varieties of cells floating in the blood stream, whether it be erythrocytes [ red blood cells ], leukocytes [ white blood cells ], and platelets).
Enter ClonoSEQ. This revolutionary technology was recently developed by the Seattle-based company Adaptive Biotechnologies founded in 2009 by brothers Chad and Harlan Robins to confirm the effectiveness of the cancer treatment as well as take preventive measures against MRD. Altogether, there are two steps in the clonoSEQ process: the ID test and the MRD test. In the first step, the doctor takes a sample of tissue from the patient, such as bone marrow or blood, and transports this biomatter to the labs of Adaptive Biotechnologies. In the labs, clonality tests are run for all possible receptors, and the receptors deemed positive in the ID test will be utilized in the following step, the MRD test.
In the second step, a clonality test are run for the positive receptors; in the progressing months, more samples are required in order to monitor the remaining cancer cells within the patient. By observing the level of success of the treatment via ClonoSEQ, doctors now have a more solid foundation for controlling the remnants of the cancer as well through successive treatment. An example of such a treatment would be autologous stem cell transplant, which entails the infusion of stem cells into the patient’ s body. Autologous stem cell transplant is a procedure in which a patient’ s own stem cells are collected and stored prior to treatment with high dose therapy that has the benefit of killing off the remaining cancer cells yet also has the detriment of killing the majority of the patient’ s blood producing cells. After the therapy, the stem cells( also known as an“ autograft”) are
8 | THE BELL NUCLEUS · Jan 2016