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Monoclonal and polyclonal gammopathy measured by serum free light chain and immunofixation subdivide the clinical outcomes of diffuse large B-cell lymphoma according to molecular classification

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Abstract

Elevated serum free light chain (FLC) is known to be an adverse prognostic factor for diffuse large B-cell lymphoma (DLBCL). We hypothesized that monoclonal gammopathy (MG; elevated kappa [κ] or lambda [λ] FLC with an abnormal κ/λ ratio or a positive IF [immunofixation]) and polyclonal gammopathy (PG; elevated κ and/or λ FLC with a normal κ/λ ratio and a negative IF) would have different clinical outcome according to the molecular classification of DLBCL. In addition, MG would be a poor prognostic factor in patients with activated B-cell like type of DLBCL. Molecular classification of DLBCL, such as germinal center B-cell (GCB) type and non-GCB type, was performed according to the Hans algorithm. Among 175 newly diagnosed DLBCL patients, 96 (54.9 %) patients had an elevated FLC. MG and PG were observed in 34 and 68 patients, respectively. The 2-year overall survival (OS) and event-free survival (EFS) rates were 79.0 % and 71.6 %, respectively. In multivariate analysis, high-intermediate/high International Prognostic Index score and elevated FLC were significant for the OS (P = 0.002, P = 0.005, respectively) and EFS (P < 0.002, P = 0.010, respectively). MG and PG were also associated with inferior OS (P = 0.002, P = 0.011, respectively) and EFS (P = 0.002, P = 0.013, respectively). Ninety-six patients from a total 133 evaluable patients were classified to the non-GCB type. Patients with PG showed inferior clinical outcome for OS and EFS in patients with the GCB type (P = 0.006, P = 0.035, respectively). MG was a significant poor prognostic factor for OS and EFS in patients with the non-GCB type (P = 0.017, P = 0.004, respectively). MG was a poor prognostic maker in patients with the non-GCB type and PG was a poor prognostic indicator for the GCB type of DLBCL who were treated with R-CHOP.

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Acknowledgments

This study was supported by a faculty research grant of Yonsei University College of Medicine for 2013 (6-2013-0141).

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The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, Gangnam Severance Hospital, Seoul, South Korea

    Yu Ri Kim

  2. Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea

    Soo-Jeong Kim, June-Won Cheong, Yundeok Kim, Ji Eun Jang, Jung Yeon Lee, Yoo Hong Min & Jin Seok Kim

  3. Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

    Jae-Woo Song

  4. Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

    Woo Ick Yang

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Kim, Y.R., Kim, SJ., Cheong, JW. et al. Monoclonal and polyclonal gammopathy measured by serum free light chain and immunofixation subdivide the clinical outcomes of diffuse large B-cell lymphoma according to molecular classification. Ann Hematol 93, 1867–1877 (2014). https://doi.org/10.1007/s00277-014-2132-y

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  • DOI: https://doi.org/10.1007/s00277-014-2132-y

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