Elevated monoclonal and polyclonal serum immunoglobulin free light chain as prognostic factors in B- and T-cell non-Hodgkin lymphoma

Thomas Elmer Witzig, Matthew J. Maurer, Thomas Matthew Habermann, Brian K. Link, Ivana Micallef, Grzegorz S Nowakowski, Stephen Maxted Ansell, Joseph P. Colgan, David J. Inwards, Luis F. Porrata, Svetomir Nenad Markovic, Patrick Bruce Johnston, Yi Lin, Carrie A Thompson, Mamta Gupta, Jerry A. Katzmann, James R Cerhan

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Abstract

The serum immunoglobulin free light chain (FLC) assay quantitates free kappa (κ) and lambda (λ) light chains. FLC elevations in patients with diffuse large B-cell lymphoma (DLBCL), Hodgkin lymphoma (HL), and chronic lymphocytic leukemia (CLL) are associated with an inferior survival. These increases in FLC can be monoclonal (as in myeloma) or polyclonal. The goal was to estimate the frequency of these elevations within distinct types of B-cell and T-cell non-Hodgkin lymphoma (NHL) and whether the FLC measurements are associated with event-free survival (EFS). We studied serum for FLC abnormalities using normal laboratory reference ranges to define an elevated κ or λ FLC. Elevations were further classified as polyclonal or monoclonal. Four hundred ninety-two patients were studied: 453 B-cell and 34 T-cell NHL patients. Twenty-nine % (142/453) of patients had an elevated FLC of which 10% were monoclonal elevations. Within B-cell NHL, FLC abnormalities were most common in lymphoplasmacytic (79%), mantle cell (68%), and lymphomas of mucosa associated lymphoid tissue (31%); they were least common in follicular (15%). The hazard ratio (HR) for EFS in all patients was 1.41 (95% CI; 1.11-1.81); in all B-cell NHL the HR was 1.44 (95% CI 1.11-1.96); in all T-cell NHL the HR was 1.17 (95% CI 0.55-2.49). FLC abnormalities predicted an inferior OS (HR = 2.75, 95% CI: 1.93-3.90, P < 0.0001). The serum FLC assay is useful for prognosis in both B-cell and T-cell types of NHL. In B-cell NHL further discrimination between a monoclonal and polyclonal elevation may be helpful and should be analyzed in prospective clinical trials.

Original languageEnglish (US)
Pages (from-to)1116-1120
Number of pages5
JournalAmerican Journal of Hematology
Volume89
Issue number12
DOIs
StatePublished - Dec 1 2014

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Immunoglobulin Light Chains
T-Cell Lymphoma
Non-Hodgkin's Lymphoma
Light
Serum
B-Cell Lymphoma
B-Lymphocytes
Disease-Free Survival
Mantle-Cell Lymphoma
Marginal Zone B-Cell Lymphoma
Lymphoma, Large B-Cell, Diffuse
B-Cell Chronic Lymphocytic Leukemia
Hodgkin Disease
Reference Values
Clinical Trials
T-Lymphocytes

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{140119cdda754d7782904de4bf07390a,
title = "Elevated monoclonal and polyclonal serum immunoglobulin free light chain as prognostic factors in B- and T-cell non-Hodgkin lymphoma",
abstract = "The serum immunoglobulin free light chain (FLC) assay quantitates free kappa (κ) and lambda (λ) light chains. FLC elevations in patients with diffuse large B-cell lymphoma (DLBCL), Hodgkin lymphoma (HL), and chronic lymphocytic leukemia (CLL) are associated with an inferior survival. These increases in FLC can be monoclonal (as in myeloma) or polyclonal. The goal was to estimate the frequency of these elevations within distinct types of B-cell and T-cell non-Hodgkin lymphoma (NHL) and whether the FLC measurements are associated with event-free survival (EFS). We studied serum for FLC abnormalities using normal laboratory reference ranges to define an elevated κ or λ FLC. Elevations were further classified as polyclonal or monoclonal. Four hundred ninety-two patients were studied: 453 B-cell and 34 T-cell NHL patients. Twenty-nine {\%} (142/453) of patients had an elevated FLC of which 10{\%} were monoclonal elevations. Within B-cell NHL, FLC abnormalities were most common in lymphoplasmacytic (79{\%}), mantle cell (68{\%}), and lymphomas of mucosa associated lymphoid tissue (31{\%}); they were least common in follicular (15{\%}). The hazard ratio (HR) for EFS in all patients was 1.41 (95{\%} CI; 1.11-1.81); in all B-cell NHL the HR was 1.44 (95{\%} CI 1.11-1.96); in all T-cell NHL the HR was 1.17 (95{\%} CI 0.55-2.49). FLC abnormalities predicted an inferior OS (HR = 2.75, 95{\%} CI: 1.93-3.90, P < 0.0001). The serum FLC assay is useful for prognosis in both B-cell and T-cell types of NHL. In B-cell NHL further discrimination between a monoclonal and polyclonal elevation may be helpful and should be analyzed in prospective clinical trials.",
author = "Witzig, {Thomas Elmer} and Maurer, {Matthew J.} and Habermann, {Thomas Matthew} and Link, {Brian K.} and Ivana Micallef and Nowakowski, {Grzegorz S} and Ansell, {Stephen Maxted} and Colgan, {Joseph P.} and Inwards, {David J.} and Porrata, {Luis F.} and Markovic, {Svetomir Nenad} and Johnston, {Patrick Bruce} and Yi Lin and Thompson, {Carrie A} and Mamta Gupta and Katzmann, {Jerry A.} and Cerhan, {James R}",
year = "2014",
month = "12",
day = "1",
doi = "10.1002/ajh.23839",
language = "English (US)",
volume = "89",
pages = "1116--1120",
journal = "American Journal of Hematology",
issn = "0361-8609",
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TY - JOUR

T1 - Elevated monoclonal and polyclonal serum immunoglobulin free light chain as prognostic factors in B- and T-cell non-Hodgkin lymphoma

AU - Witzig, Thomas Elmer

AU - Maurer, Matthew J.

AU - Habermann, Thomas Matthew

AU - Link, Brian K.

AU - Micallef, Ivana

AU - Nowakowski, Grzegorz S

AU - Ansell, Stephen Maxted

AU - Colgan, Joseph P.

AU - Inwards, David J.

AU - Porrata, Luis F.

AU - Markovic, Svetomir Nenad

AU - Johnston, Patrick Bruce

AU - Lin, Yi

AU - Thompson, Carrie A

AU - Gupta, Mamta

AU - Katzmann, Jerry A.

AU - Cerhan, James R

PY - 2014/12/1

Y1 - 2014/12/1

N2 - The serum immunoglobulin free light chain (FLC) assay quantitates free kappa (κ) and lambda (λ) light chains. FLC elevations in patients with diffuse large B-cell lymphoma (DLBCL), Hodgkin lymphoma (HL), and chronic lymphocytic leukemia (CLL) are associated with an inferior survival. These increases in FLC can be monoclonal (as in myeloma) or polyclonal. The goal was to estimate the frequency of these elevations within distinct types of B-cell and T-cell non-Hodgkin lymphoma (NHL) and whether the FLC measurements are associated with event-free survival (EFS). We studied serum for FLC abnormalities using normal laboratory reference ranges to define an elevated κ or λ FLC. Elevations were further classified as polyclonal or monoclonal. Four hundred ninety-two patients were studied: 453 B-cell and 34 T-cell NHL patients. Twenty-nine % (142/453) of patients had an elevated FLC of which 10% were monoclonal elevations. Within B-cell NHL, FLC abnormalities were most common in lymphoplasmacytic (79%), mantle cell (68%), and lymphomas of mucosa associated lymphoid tissue (31%); they were least common in follicular (15%). The hazard ratio (HR) for EFS in all patients was 1.41 (95% CI; 1.11-1.81); in all B-cell NHL the HR was 1.44 (95% CI 1.11-1.96); in all T-cell NHL the HR was 1.17 (95% CI 0.55-2.49). FLC abnormalities predicted an inferior OS (HR = 2.75, 95% CI: 1.93-3.90, P < 0.0001). The serum FLC assay is useful for prognosis in both B-cell and T-cell types of NHL. In B-cell NHL further discrimination between a monoclonal and polyclonal elevation may be helpful and should be analyzed in prospective clinical trials.

AB - The serum immunoglobulin free light chain (FLC) assay quantitates free kappa (κ) and lambda (λ) light chains. FLC elevations in patients with diffuse large B-cell lymphoma (DLBCL), Hodgkin lymphoma (HL), and chronic lymphocytic leukemia (CLL) are associated with an inferior survival. These increases in FLC can be monoclonal (as in myeloma) or polyclonal. The goal was to estimate the frequency of these elevations within distinct types of B-cell and T-cell non-Hodgkin lymphoma (NHL) and whether the FLC measurements are associated with event-free survival (EFS). We studied serum for FLC abnormalities using normal laboratory reference ranges to define an elevated κ or λ FLC. Elevations were further classified as polyclonal or monoclonal. Four hundred ninety-two patients were studied: 453 B-cell and 34 T-cell NHL patients. Twenty-nine % (142/453) of patients had an elevated FLC of which 10% were monoclonal elevations. Within B-cell NHL, FLC abnormalities were most common in lymphoplasmacytic (79%), mantle cell (68%), and lymphomas of mucosa associated lymphoid tissue (31%); they were least common in follicular (15%). The hazard ratio (HR) for EFS in all patients was 1.41 (95% CI; 1.11-1.81); in all B-cell NHL the HR was 1.44 (95% CI 1.11-1.96); in all T-cell NHL the HR was 1.17 (95% CI 0.55-2.49). FLC abnormalities predicted an inferior OS (HR = 2.75, 95% CI: 1.93-3.90, P < 0.0001). The serum FLC assay is useful for prognosis in both B-cell and T-cell types of NHL. In B-cell NHL further discrimination between a monoclonal and polyclonal elevation may be helpful and should be analyzed in prospective clinical trials.

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