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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

 Yu Ri Kim  ;  Soo-Jeong Kim  ;  June-Won Cheong  ;  Yundeok Kim  ;  Ji Eun Jang  ;  Jung Yeon Lee  ;  Yoo Hong Min  ;  Jae-Woo Song  ;  Woo Ick Yang  ;  Jin Seok Kim 
 ANNALS OF HEMATOLOGY, Vol.1007(10) : 1867-1877, 2014 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Biomarkers, Tumor/blood* ; Biomarkers, Tumor/classification ; Female ; Humans ; Immunoglobulin Light Chains/blood* ; Immunoglobulin Light Chains/classification ; Lymphoma, Large B-Cell, Diffuse/blood* ; Lymphoma, Large B-Cell, Diffuse/diagnosis* ; Lymphoma, Large B-Cell, Diffuse/mortality ; Male ; Middle Aged ; Paraproteinemias/blood* ; Paraproteinemias/diagnosis* ; Paraproteinemias/mortality ; Retrospective Studies ; Survival Rate/trends ; Treatment Outcome ; Young Adult
Diffuse large B-cell lymphoma ; Germinal center B-cell type ; Non-germinal center B-cell type ; Monoclonal gammopathy ; Polyclonal gammopathy ; Serum free light chain ; Immunofixation
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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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
Yonsei Authors
Kim, Soo Jeong(김수정) ORCID logo https://orcid.org/0000-0001-8859-3573
Kim, Yu Ri(김유리) ORCID logo https://orcid.org/0000-0001-5505-0142
Kim, Yun Deok(김윤덕) ORCID logo https://orcid.org/0000-0002-5336-7936
Kim, Jin Seok(김진석) ORCID logo https://orcid.org/0000-0001-8986-8436
Min, Yoo Hong(민유홍) ORCID logo https://orcid.org/0000-0001-8542-9583
Song, Jae Woo(송재우) ORCID logo https://orcid.org/0000-0002-1877-5731
Yang, Woo Ick(양우익) ORCID logo https://orcid.org/0000-0002-6084-5019
Lee, Jung Yoen(이정연)
Jang, Ji Eun(장지은) ORCID logo https://orcid.org/0000-0001-8832-1412
Cheong, June-Won(정준원) ORCID logo https://orcid.org/0000-0002-1744-0921
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