免疫球蛋白重链重排与 18F-FDG-PET/CT 检测弥漫性大 B 细胞淋巴瘤患者骨髓侵犯的诊断准确性和预后相关性与单侧骨髓活检比较。
Diagnostic Accuracy and Prognostic Relevance of Immunoglobulin Heavy Chain Rearrangement and 18F-FDG-PET/CT Compared With Unilateral Bone Marrow Trephination for Detecting Bone Marrow Involvement in Patients With Diffuse Large B-Cell Lymphoma.
机构信息
Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea.
Department of Laboratory Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea.
出版信息
J Korean Med Sci. 2022 Jan 3;37(1):e2. doi: 10.3346/jkms.2022.37.e2.
BACKGROUND
In diffuse large B-cell lymphoma (DLBCL), bone marrow involvement (BMI) has an important clinical implication as a component of staging and International Prognostic Index. This study aimed to determine whether molecular analysis of immunoglobulin heavy chain (IgH) genes and positron emission tomography-computed tomography (PET/CT) could overcome the limitation of defining morphologic BMI by trephination biopsy and could increase the diagnostic accuracy or prognostic prediction.
METHODS
A total of 94 de novo patients with DLBCL underwent PET/CT, polymerase chain reaction (PCR) test for detection of IgH gene rearrangement, and unilateral bone marrow (BM) trephination at diagnosis.
RESULTS
A total of 9 patients (9.6%) were confirmed to present morphologic BMI (mBMI) based on trephination biopsy. On the other hand, 21 patients (22.3%) were confirmed to have IgH clonality (IgH BMI), while 16 (17.0%) were classified with BMI based on the assessment of PET/CT (PET BMI). Each IgH rearrangement PCR and PET/CT showed the high negative predictive value of detecting the BMI. However, the combined assessment of IgH rearrangement and PET/CT could increase the diagnostic accuracy and specificity with 87.2% and 97.0%, respectively. The survival outcome of patients with double positive PET BMI and IgH BMI was significantly worse than that with either single positive PET BMI or IgH BMI, and even less than patients with neither PET BMI nor IgH BMI (3-year PFS: 50.0% vs. 75.4% vs. 97.9%, = 0.007, 3-year OS: 50.0% vs. 75.6% vs. 80.1%, = 0.035, respectively).
CONCLUSION
This study suggests that the combined evaluation of PET/CT and IgH rearrangement could give additional information for predicting therapeutic outcomes in patients with negative morphologic BMI as an important part of the prognosis.
背景
在弥漫性大 B 细胞淋巴瘤（DLBCL）中，骨髓受累（BMI）作为分期和国际预后指数的一个组成部分具有重要的临床意义。本研究旨在确定免疫球蛋白重链（IgH）基因的分子分析和正电子发射断层扫描-计算机断层扫描（PET/CT）是否可以克服通过活检穿刺来定义形态学 BMI 的局限性，并提高诊断准确性或预后预测。
方法
共 94 例初治 DLBCL 患者在诊断时接受了 PET/CT、聚合酶链反应（PCR）检测 IgH 基因重排以及单侧骨髓（BM）活检。
结果
根据活检穿刺，共有 9 例（9.6%）患者被确诊为形态学 BMI（mBMI）。另一方面，21 例（22.3%）患者被确诊为 IgH 克隆性（IgH BMI），16 例（17.0%）患者根据 PET/CT 评估被归类为 BMI（PET BMI）。每个 IgH 重排 PCR 和 PET/CT 均显示出检测 BMI 的高阴性预测值。然而，IgH 重排与 PET/CT 的联合评估可分别提高诊断准确性和特异性，分别为 87.2%和 97.0%。双阳性 PET BMI 和 IgH BMI 患者的生存结局明显差于单阳性 PET BMI 或 IgH BMI 患者，甚至差于既无 PET BMI 也无 IgH BMI 的患者（3 年 PFS：50.0%比 75.4%比 97.9%， = 0.007，3 年 OS：50.0%比 75.6%比 80.1%， = 0.035）。
结论
本研究表明，PET/CT 和 IgH 重排的联合评估可为预测阴性形态学 BMI 患者的治疗结果提供额外信息，是预后的重要组成部分。
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