Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.
Leuk Res. 2011 Aug;35(8):1060-5. doi: 10.1016/j.leukres.2010.12.005. Epub 2011 Jan 3.
The aim of this study was to explore the clinical and other associated laboratory features of chronic lymphocytic leukemia (CLL) patients with immunoglobulin (Ig) paraproteinemia. Serum protein electrophoresis (SPE) and immunofixation electrophoresis (IFE) were performed to measure serum Ig paraprotein. The correlations between serum Ig paraprotein and other prognostic factors were analyzed. Univariate and multivariate Cox regression analyses were used to assess associations between survival time and potential risk factors. In 133 Chinese CLL patients, 27 (20.3%) patients occurred Ig paraproteinemia at diagnosis. According to the correlation analysis, advanced Binet stage (r=0.314, P<0.001), direct antiglobulin test (DAT)-positive (r=0.366, P<0.001), high level of serum β2-microglobulin (β2-MG) (r=0.296, P=0.001) and thymidine kinase (TK) 1 (r=0.227, P=0.037), unmutated immunoglobulin heavy chain variable gene (IGHV) status (r=0.284, P=0.002), ZAP-70-positive (r=0.305, P=0.001), CD38-positive (r=0.284, P=0.002), and cytogenetic abnormalities of del(17p13) or del(11q22.3) (r=0.208, P=0.032) emerged as factors significantly related to the occurrence of Ig paraproteinemia. Survival analysis showed that the patients with Ig paraproteinemia had significantly shorter survival times than the patients without serum Ig paraprotein (P=0.013). Binet stage (P=0.028), high levels of lactate dehydrogenase (LDH) (P=0.004), IgG paraproteinemia (P=0.048), IgM paraproteinemia (P=0.001), ZAP-70-positive (P=0.003), DAT-positive (P=0.013), unmutated IGHV status (P=0.009), and del(17p13) (P=0.001) were the adverse factors in determining overall survival (OS). Del(17p13) (P=0.006), ZAP-70 (P=0.030), and IgM paraproteinemia (P=0.040) were the variables strongly associated with OS by multivariate Cox regression analysis. It was showed that serum Ig paraprotein might be applied for the assessment of prognosis in patients with CLL.
本研究旨在探讨伴有免疫球蛋白（Ig）副蛋白血症的慢性淋巴细胞白血病（CLL）患者的临床和其他相关实验室特征。通过血清蛋白电泳（SPE）和免疫固定电泳（IFE）来测量血清 Ig 副蛋白。分析血清 Ig 副蛋白与其他预后因素之间的相关性。采用单因素和多因素 Cox 回归分析来评估生存时间与潜在风险因素之间的关联。在 133 例中国 CLL 患者中，27 例（20.3%）患者在诊断时发生 Ig 副蛋白血症。根据相关性分析，晚期 Binet 分期（r=0.314，P<0.001）、直接抗球蛋白试验（DAT）阳性（r=0.366，P<0.001）、血清β2-微球蛋白（β2-MG）水平高（r=0.296，P=0.001）和胸苷激酶（TK）1 高（r=0.227，P=0.037）、未突变免疫球蛋白重链可变基因（IGHV）状态（r=0.284，P=0.002）、ZAP-70 阳性（r=0.305，P=0.001）、CD38 阳性（r=0.284，P=0.002）和 del(17p13)或 del(11q22.3)的细胞遗传学异常（r=0.208，P=0.032）是与 Ig 副蛋白血症发生显著相关的因素。生存分析显示，伴有 Ig 副蛋白血症的患者的生存时间明显短于无血清 Ig 副蛋白的患者（P=0.013）。Binet 分期（P=0.028）、乳酸脱氢酶（LDH）水平高（P=0.004）、IgG 副蛋白血症（P=0.048）、IgM 副蛋白血症（P=0.001）、ZAP-70 阳性（P=0.003）、DAT 阳性（P=0.013）、未突变 IGHV 状态（P=0.009）和 del(17p13)（P=0.001）是影响总生存期（OS）的不良因素。多因素 Cox 回归分析显示，del(17p13)（P=0.006）、ZAP-70（P=0.030）和 IgM 副蛋白血症（P=0.040）是与 OS 密切相关的变量。结果表明，血清 Ig 副蛋白可用于评估 CLL 患者的预后。
