Significance Of Serum Monoclonal Immunoglobulins In Chronic B Lymphocytic Prolifer Ative Diseases

BackgroundChronic B lymphocytic proliferative diseases(B-CLPD)is a mature B cell clonal proliferative disease involved peripheral blood or bone marrow.Monoclonal immunoglobulins(McIg)is the hallmark of plasma cell proliferative disorders.It usually be seen in multiple myeloma and Waldenstrom's macroglobulinemia(WM).An increasing number of studies have observed that abnormally high levels of McIg are detected in many human cancer types,in the case of Liver cancer,lung cancer,colorectal cancer and breast cancer.Tumor tissues express greater and more frequent IgG? IgA or IgM than its adjacent normal tissues.Several studies have indicated that IgG and IgA can increase tumour cell proliferation.Whatmore,a few reports have found that abnormally high levels of McIg are detected in hematologic cancers,examples are myelodysplastic syndromes(MDS)and acute myeloid leukemia(AML).However,at present,there are only some association studies between McIg and B-CLPD and they are more controversial.It have been described that the prognosis of CLL patients with positive McIgM paraprotein was worse than that of IgM negative patients.But,another research found that there was no significant difference between them with respect to overall survival.In order to improve the recognition of lymphoma with McIg,we will analysis the incidence of McIg in patients with B-CLPD diagnosed in recent years and investigate the prognostic significance of McIg in B-CLPD exdluding WM.ObjectiveTo investigate the incidence of serum monoclonal immunoglobulins(McIg)in chronic B lymphocytic proliferative diseases(B-CLPD)and the prognostic significance of McIg in B-CLPD exdluding Waldenstrom's macroglobulinemia(WM).MethodsA total of 1147 patients with B-CLPD treated in Institute of Hematology from May2006 to May 2015 were enrolled into this retrospective study.To analyse the incidence of McIg and the relationship between McIg and prognostic factors in patients with B-CLPD.Results1.Out of 1147 B-CLPD patients,there were 164 patients with LPL/WM and among them,140 cases(85.4%)were detected McIg.In the remaining 983 patients with B-CLPD,monoclonal Ig was detected in 50(5.1%)patients,most of whom were IgM paraprotein.2.The level of IgM paraprotein in serum of the LPL/WM group was significantly higher than that in the non-LPL/WM group(P=0.005).3.The level of paraprotein decreased significantly when the patients got complete response after therapy.4.The incidence of serum McIg was higher in the group with complex karyotype(P=0.016)and in the group with high level of beta-2-microglobulin(?2-MG)(P= 0.001).In the 47 non-LPL/WM patients,40(85.11%)serum McIg were expressed in a pattern consistent with the distribution of tumor cells(P=0.02).5.Most of the light chain subtype of the McIg were consistent with the light chain subtype of the membrane immunoglobulin on the tumor cells.ConclusionMcIg can be detected in a subset of patients with B-CLPD except LPL/WM,and the McIg may be secreted by tumor cells.Moreover,it could have certain relevance with the prognosis of B-CLPD.