Answers from the Lab

(00:32):

Before we get into the test itself, Dr. Mills, I'd love for you to tell our audience just a little bit about yourself, your background, your role here at Mayo clinic.

(01:41):

Can you just give our audience a brief overview of the assay?

(05:20):

I really appreciate how the lab has looked at other approaches and decided that this is the best one. Is that an accurate kind of summary.

(06:16):

They'll get the result that they need with just one test, right?

(07:03):

So can you start with helping our physicians understand which patients should get this testing?

(09:05):

You said these immune mediated neuropathies, this test is going to be important for all of those to help, to identify the distinct phenotype of neurofascin155, right, Dr. Mills?

(09:43):

I know you mentioned that these are rare disorders, but how common is the neurofascin antibody in that phenotype?

(11:27):

Dr. Mills, are there any other alternative options regarding this kind of testing?

(13:30):

How is the positive or negative result going to drive the physician in a certain direction regarding prognosis or treatment? Can you share some of that?

(14:48):

Do you think there are any prerequisites that physicians should be testing for these particular things before they would order our neurofascin test or does the neurofascin come pretty early on in the differential?

(15:36):

Can you elaborate a little more on the next steps? What does a more aggressive treatment plan? What does that mean?

(16:09):

We've talked about a lot of the important items, the assay and how it's designed, how this is going to help patient care and how it's unique, but what's your key takeaway here? What are you most excited about?

(00:32):

Before we get started, Dr. Hasadsri, could you provide us with a little bit about you and your background?

(02:43):
Can you differentiate a little bit between what we offer from a molecular standpoint, but what we offer from a biochemical genetic standpoint in terms of mitochondrial testing?

(06:25):
When you would utilize this mitochondrial testing and what kind of patient treatment is this kind of testing guide? How is this utilized in terms of the way the patient is treated?

(09:10):
How does the testing that Mayo clinic lab offers in terms of mitochondrial differ from what other labs are offering right now in the same area?

(13:33):
Is there anything you can think of that you would want to add to all of this or anything you think that we we've left out? I think you've been very comprehensive, but I just wanted to end with that and just see if there was anything else that you wanted to say?

Resources
GDF15 | Growth Differentiation Factor 15, Plasma

OAU | Organic Acids Screen, Urine

AAQP | Amino Acids, Quantitative, Plasma

TQ10 | Celiac Disease Serology Cascade, Serum

FAPM | Fatty Acid Profile, Mitochondrial (C8-C18), Serum

PYR/PYRC | CPyruvic Acid, Blood/ Pyruvate, Spinal Fluid

PDHC | Pyruvate Dehydrogenase Complex (PDHC), Fibroblasts

MITOP | Mitochondrial Full Genome Analysis by Next-Generation Sequencing (NGS), Varies

MITON | Mitochondrial Nuclear Gene Panel by Next-Generation Sequencing (NGS), Varies

MITOT | Combined Mitochondrial Analysis, Mitochondrial Full Genome and Nuclear Gene Panel, Varies

(00:32)
 Thanks for that introduction, Dr. Pritt. Today, we're actually going to be discussing T-cell lymphomas with Dr. Andrew Feldman. But before we really get started talking about this disease state, Dr. Feldman, could you provide us with a little bit of background about you and your role here at Mayo Clinic?

(01:10)
 So at your work at Mayo clinic, you’re involved in the clinical side and that you're reading all of these patient cases as a meta-pathologist, but you also have a research focus as well. Is that specific to T-cell lymphomas? 
 
 (01:38)
 That's interesting. That gives you a very unique perspective being that you're involved kind of in both sides of that. So as we talk about T-cell lymphoma, can you just give myself and our listeners kind of a brief overview of this disease state?

(03:48)
 So, Dr. Feldman, I find it really interesting as you, you kind of talk about this disease state. I didn't realize there were 30 subtypes of T-cell lymphoma. I mean, that does definitely add to the complexity of this. So can you talk to me really about what are the different tests and assays that you use to sub classify into those 30 types and give our patients an accurate diagnosis?

(06:19)
 This never ceases to amaze me about the amount of pathology and hematology and hematologic malignancies in general. There's no one test that answers the questions that we have for these patients. You kind of have to work your way down, putting all of these different pieces together. And I always think about it like a puzzle. So as you're going through and in answering these questions and you put this puzzle together for each patient, when should patients be having this testing performed? Do we do it at diagnosis? Are we following these patients? Kind of talk to me about that process as the patient comes in to see their oncologist for these diseases.

(07:39)
 So Dr. Feldman, it's interesting that you talked about all of these tests that we perform to try to accurately diagnose these patients and that we're using them to give the clinician all of those answers that they need to treat their patients. As we come up with that final diagnosis and we give the clinician their answer, how are those results being used in patient care? I've seen a lot of movement in the marketplace lately with new therapies, new gene findings. What are those answers that we're giving those clinicians doing for those patients in the long run?

(11:10)
 Just so interesting to me, all the complexities of this and the nuances that go into making sure that that patient gets put on the right therapy that is actually beneficial for them and not harmful in some cases. So last question, just because it's kind of a hot topic right now in the oncology world in general. So, are we monitoring these types of lymphoma patients right now for any sort of minimal residual disease or what kind of monitoring happens for these patients during the course of therapy,

(12:08)
 Oh, that's very interesting. And I look forward to that, especially hearing you talk about how some of these therapies are being very successful for these patients. It'll be good to see what does that progression-free survival look like and what does that patient quality of life right after they've gone through these therapies. I really enjoy hearing that we're having these increased successes. So one last question for you before I let you go, you've done a lot of research in the T-cell lymphoma space. It's obviously something that's really near and dear to your heart. You also see a lot of consults and our team sees a lot of consults on T-cell lymphomas, just because of our expertise in this area. Just really quickly tell me about all of the work that you've done. What's the one thing that really stands out. She was like, this was that thing that you found or that, that driver of what, what brings you to work every day that you just are really always excited.

Additional Resources
https://covid.cdc.gov/covid-data-tracker/#county-view
https://www.whitehouse.gov/covidplan/

(00:31)

Dr. Moyer, could you provide us a little bit about you and your background?

(01:18)
 Would you mind sharing just a brief overview of the focus pharmacogenomics panel?

(03:32)
 So coming back to that patient focus, which patients should have this testing? And when do you recommend to be performed?

(05:17)
 Can you talk a little bit about what alternative test options are available and how they compare?
 
 (07:58)
 Can you comment on how the results from this test are used in patient care?

(11:55)

Any final thoughts you'd leave us with before we wrap up?