Zhang Yian, Wei Zheng, Li Jing, Gao Rupan, Liu Peng
Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China.
Medicine (Baltimore). 2018 Jul;97(30):e11719. doi: 10.1097/MD.0000000000011719.
Monoclonal gammopathy (MG), a positive result of serum immunofixation electrophoresis (SIFE), has been reported in cases of diffuse large B-cell lymphoma (DLBCL). We performed this study to further investigate the prognostic value of MG in DLBCL.We retrospectively reviewed patients diagnosed with DLBCL between January 2007 and December 2014, and identified 37 patients with MG. The clinical characteristics of these patients were then reviewed. A 1:2 case-control analysis was conducted on 74 matched controls, who were patients with DLBCL and without MG. Both cases and controls were age-matched and were diagnosed within the same year.Among 37 DLBCL patients with MG, the monoclonal component of IgM was the most frequent compared to the other subtypes. Laboratory tests showed that the presence of MG was correlated with a decreased platelet-to-lymphocyte ratio (PLR). Survival analysis showed that MG-secreting DLBCL patients had an inferior overall survival (OS) and progression-free survival (PFS), compared with MG-nonsecreting patients, regardless of MG subtype. However, treatment response analysis showed that MG was not a good indicator for tumor relapse. When patients with DLBCL were grouped by immunophenotype, we found that MG was associated with poor prognosis in the non-germinal center B-cell-like (GCB) type, rather than GCB type in OS analysis. Meanwhile, there was no statistical significance upon PFS analysis in both immunophenotypes. Furthermore, our study found that the appearance of MG during treatment did make prognostic sense compared to nonsecretors.Overall, MG can serve as a prognostic factor for DLBCL. We hypothesize that its presence in DLBCL may reflect the immune microenvironment in tumor progression and warrants further study to unveil the underlying molecular pathogenesis.
单克隆丙种球蛋白病（MG）是血清免疫固定电泳（SIFE）的阳性结果，已在弥漫性大B细胞淋巴瘤（DLBCL）病例中被报道。我们进行这项研究以进一步探究MG在DLBCL中的预后价值。我们回顾性分析了2007年1月至2014年12月期间诊断为DLBCL的患者，确定了37例患有MG的患者。然后回顾了这些患者的临床特征。对74例匹配的对照进行了1:2病例对照分析，这些对照是患有DLBCL但无MG的患者。病例组和对照组年龄匹配且在同一年被诊断。在37例患有MG的DLBCL患者中，与其他亚型相比，IgM的单克隆成分最为常见。实验室检查表明，MG的存在与血小板与淋巴细胞比值（PLR）降低相关。生存分析表明，无论MG亚型如何，分泌MG的DLBCL患者的总生存期（OS）和无进展生存期（PFS）均低于不分泌MG的患者。然而，治疗反应分析表明，MG不是肿瘤复发的良好指标。当根据免疫表型对DLBCL患者进行分组时，我们发现在OS分析中，MG与非生发中心B细胞样（GCB）型而非GCB型的预后不良相关。同时，在两种免疫表型的PFS分析中均无统计学意义。此外，我们的研究发现，与不分泌者相比，治疗期间MG的出现确实具有预后意义。总体而言，MG可作为DLBCL的预后因素。我们推测其在DLBCL中的存在可能反映了肿瘤进展过程中的免疫微环境，值得进一步研究以揭示潜在的分子发病机制。
