The relationship between the presence of MG and biological tumor behavior, however, remains obscure. We observed that patients with DLBCL, who had positive SIFE results, also known as MG-secreting DLBCL, shared poor prognosis after receiving immunochemotherapy. Besides these PCDs, there are approximately 17% of lymphoma patients of various subtypes reported to present with positive SIFE results. Usually, a positive SIFE result refers to the discovery of serum monoclonal gammopathies (MG), and such results are mainly observed in patients with multiple myeloma (MM), monoclonal gammopathies of undetermined significance (MGUS), etc. Compared to serum free light chain (FLC) testing, which is becoming a mainstream screening test for plasma cell diseases (PCD), SIFE remains a lower-cost test, and is more widely used in clinical practice. Serum immunofixation electrophoresis (SIFE) technology is used to identify monoclonal or polyclonal gammopathies. Despite the rise of interests in these areas, there is still a strong need to discover more prognostic factors based on tumor phenotypes that will probably improve risk-adapted treatment approaches. In addition, several markers have been discovered in DLBCL, to better identify patients who will likely have a poor therapeutic response. To better distinguish tumor prognosis, several models and algorithms have been developed. However, the International Prognostic Index (IPI), which was developed in the era of chemotherapy treatment for aggressive lymphoma, has proven to be less powerful in the rituximab era. Owing to the use of rituximab, progression-free survival (PFS) and overall survival (OS) rates in DLBCL have improved. Standard treatment for DLBCL includes a combination of biological therapy consisting of rituximab and anthracycline-based chemotherapy regimens, usually comprising cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). 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.ĭiffuse large B-cell lymphoma (DLBCL) is the most common pathologic type of high-grade non-Hodgkin lymphoma among adults, with an estimated annual incidence of 7 to 8 cases per 100,000 people every year. Overall, MG can serve as a prognostic factor for DLBCL. Furthermore, our study found that the appearance of MG during treatment did make prognostic sense compared to nonsecretors. Meanwhile, there was no statistical significance upon PFS analysis in both immunophenotypes. 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. However, treatment response analysis showed that MG was not a good indicator for tumor relapse. 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. Laboratory tests showed that the presence of MG was correlated with a decreased platelet-to-lymphocyte ratio (PLR). Both cases and controls were age-matched and were diagnosed within the same year.Īmong 37 DLBCL patients with MG, the monoclonal component of IgM was the most frequent compared to the other subtypes. A 1:2 case-control analysis was conducted on 74 matched controls, who were patients with DLBCL and without MG. The clinical characteristics of these patients were then reviewed. We retrospectively reviewed patients diagnosed with DLBCL between January 2007 and December 2014, and identified 37 patients with MG. We performed this study to further investigate the prognostic value of MG in DLBCL. Her clinical practice is focused on oncologic and complex reconstruction with an emphasis on breast reconstruction, sarcoma reconstruction and microsurgery.Monoclonal gammopathy (MG), a positive result of serum immunofixation electrophoresis (SIFE), has been reported in cases of diffuse large B-cell lymphoma (DLBCL). She is recognized for her contributions in patient care, education, and research. Zhang began her practice in plastic and reconstructive surgery at The Ottawa Hospital in 2014. Her fellowship training included a hand and upper extremity surgery at the University of Toronto (2013) and microsurgical breast reconstruction at the University of Manitoba (2014).ĭr. She obtained a Ph.D in Oncology at the University of Alberta (2005) and in 2013 she pursued her residency training in plastic and reconstructive surgery at the University of Toronto. Zhang received her medical degree from Chongqing Medical School in China (1998). Jing Zhang is a plastic surgeon with a special interest in breast surgery, hand surgery and reconstructive microsurgery.ĭr.
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