Detection of Hematological Malignancies Using N-NOSE (Nematode-NOSE)

Abstract

Hematological malignancies often lack defined risk factors and present with non-specific symptoms, underscoring the urgent need for simple and reliable detection methods. To address this challenge, Hirotsu et al. innovated N-NOSE, a novel, non-invasive cancer screening test that utilizes the chemotaxis response of the nematode Caenorhabditis elegans to detect tumor-related odors in urine. In this clinical study, we assessed the performance of N-NOSE in patients with various hematological malignancies at diagnosis and during treatment. Urine samples were collected from 30 healthy individuals and 89 patients, including those with leukemia (n = 13), malignant lymphoma (n = 53), multiple myeloma (n = 15), primary AL amyloidosis (n = 3), Waldenström's macroglobulinemia (n = 2), myelodysplastic syndrome (n = 2), and blastic plasmacytoid dendritic cell neoplasm (n = 1). Based on the optimal cut-off values in detecting hematological malignancies, N-NOSE demonstrated high positivity rates in treatment-naïve patients: leukemia and multiple myeloma were very high (over 90%), whereas malignant lymphoma was slightly lower than 80%. In the small subset of malignant lymphoma patients who tested N-NOSE-negative, confounding factors included steroid administration and hemodialysis. Importantly, no significant correlation emerged between N-NOSE index values and baseline characteristics or comorbidities other than the presence of cancer. Moreover, in all 32 patients who achieved clinical response following chemotherapy, the N-NOSE index declined, reflecting disease status. These findings highlight N-NOSE's strong potential as a sensitive, non-invasive screening tool for hematological malignancies—particularly multiple myeloma—and support its use in initial detection and monitoring of therapeutic response.