Tittle Victoria, Rayment Michael, Keeling Emma, Gabriel Ian, Yarranton Helen, Bower Mark
aDepartment of HIV and Sexual Health bDepartment of Haematology cDepartment of Oncology, Chelsea and Westminster Hospital, London, UK.
AIDS. 2015 Jun 19;29(10):1201-4. doi: 10.1097/QAD.0000000000000699.
Serum-free light chains (sFLCs) are a biomarker of B-cell proliferation. Two case-control studies found elevated levels of polyclonal sFLCs predict the development of HIV-associated lymphomas (HALs) in people living with HIV. This effect appears greater for non-Hodgkin's lymphomas than Hodgkin's lymphoma. In this study, we measured sFLCs at diagnosis of HALs, and correlated levels with histology and survival.
The clinic database of the National Centre for HIV Malignancy was used to identify HAL patients, in the antiretroviral treatment era. Levels of sFLCs were measured using stored sera (cases from 1996 to 2008) and prospectively from 2008 to 2014. Serum immunoglobulins were available for 201 patients. We assessed correlations between sFLCs, serum immunoglobulins, and histological subtypes and overall survival.
Two hundred and sixty-four patients were identified and 70% had polyclonal sFLC, 8% monoclonal sFLC (90% kappa sFLC), and 22% normal sFLC levels. No significant difference in sFLCs was observed between the three major histological subtypes of HAL (Hodgkin's lymphoma, diffuse large B-cell lymphoma, and Burkitt lymphoma). Elevated sFLCs did not influence overall survival in HAL or for the three subtypes individually.
Whilst these data confirm the finding of elevated sFLC in HAL, there was no significant difference in sFLC measurements between histological subtypes despite differences in pathogenesis. sFLC did not predict survival in HAL overall or by histological subtype. Elevated sFLCs may predict HAL, but measurement of sFLCs has limited utility in the classification and prognostication of these cases.
游离轻链（sFLC）是B细胞增殖的生物标志物。两项病例对照研究发现，多克隆sFLC水平升高可预测HIV感染者发生HIV相关淋巴瘤（HAL）。这种效应在非霍奇金淋巴瘤中似乎比霍奇金淋巴瘤更明显。在本研究中，我们在HAL诊断时测量了sFLC，并将其水平与组织学和生存率进行了关联。
利用国家HIV恶性肿瘤中心的临床数据库，在抗逆转录病毒治疗时代识别HAL患者。使用储存血清（1996年至2008年的病例）并在2008年至2014年进行前瞻性测量sFLC水平。201例患者可获得血清免疫球蛋白。我们评估了sFLC、血清免疫球蛋白、组织学亚型与总生存率之间的相关性。
共识别出264例患者，70%有多克隆sFLC，8%有单克隆sFLC（90%为κ轻链型sFLC），22%的sFLC水平正常。HAL的三种主要组织学亚型（霍奇金淋巴瘤、弥漫性大B细胞淋巴瘤和伯基特淋巴瘤）之间的sFLC无显著差异。sFLC升高对HAL的总生存率或三种亚型的生存率均无影响。
虽然这些数据证实了HAL中sFLC升高的发现，但尽管发病机制不同，各组织学亚型之间的sFLC测量值并无显著差异。sFLC不能预测HAL的总体生存率或按组织学亚型的生存率。sFLC升高可能预测HAL，但sFLC测量在这些病例的分类和预后评估中的作用有限。
