title: Prognostic significance of serum immunoglobulin paraprotein in patients with chronic lymphocytic leukemia.
abstract: The aim of this study was to explore the clinical and other associated laboratory features of chronic lymphocytic leukemia (CLL) patients with immunoglobulin (Ig) paraproteinemia. Serum protein electrophoresis (SPE) and immunofixation electrophoresis (IFE) were performed to measure serum Ig paraprotein. The correlations between serum Ig paraprotein and other prognostic factors were analyzed. Univariate and multivariate Cox regression analyses were used to assess associations between survival time and potential risk factors. In 133 Chinese CLL patients, 27 (20.3%) patients occurred Ig paraproteinemia at diagnosis. According to the correlation analysis, advanced Binet stage (r=0.314, P<0.001), direct antiglobulin test (DAT)-positive (r=0.366, P<0.001), high level of serum β2-microglobulin (β2-MG) (r=0.296, P=0.001) and thymidine kinase (TK) 1 (r=0.227, P=0.037), unmutated immunoglobulin heavy chain variable gene (IGHV) status (r=0.284, P=0.002), ZAP-70-positive (r=0.305, P=0.001), CD38-positive (r=0.284, P=0.002), and cytogenetic abnormalities of del(17p13) or del(11q22.3) (r=0.208, P=0.032) emerged as factors significantly related to the occurrence of Ig paraproteinemia. Survival analysis showed that the patients with Ig paraproteinemia had significantly shorter survival times than the patients without serum Ig paraprotein (P=0.013). Binet stage (P=0.028), high levels of lactate dehydrogenase (LDH) (P=0.004), IgG paraproteinemia (P=0.048), IgM paraproteinemia (P=0.001), ZAP-70-positive (P=0.003), DAT-positive (P=0.013), unmutated IGHV status (P=0.009), and del(17p13) (P=0.001) were the adverse factors in determining overall survival (OS). Del(17p13) (P=0.006), ZAP-70 (P=0.030), and IgM paraproteinemia (P=0.040) were the variables strongly associated with OS by multivariate Cox regression analysis. It was showed that serum Ig paraprotein might be applied for the assessment of prognosis in patients with CLL.
authors.affiliation: Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
authors.forename: Yin-Hua
authors.initials: YH
authors.lastname: Wang
authors.forename: Lei
authors.initials: L
authors.lastname: Fan
authors.forename: Cheng
authors.initials: C
authors.lastname: Fang
authors.forename: Dan-Xia
authors.initials: DX
authors.lastname: Zhu
authors.forename: Dong-Mei
authors.initials: DM
authors.lastname: Wang
authors.forename: Chun
authors.initials: C
authors.lastname: Qiao
authors.forename: Yu-Jie
authors.initials: YJ
authors.lastname: Wu
authors.forename: Jian-Yong
authors.initials: JY
authors.lastname: Li
mesh_terms: D051997:ADP-ribosyl Cyclase 1 / Q000097:blood; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D002872:Chromosome Deletion; D015331:Cohort Studies; D020732:Cytogenetic Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007143:Immunoglobulin Heavy Chains / Q000235:genetics; D017404:In Situ Hybridization, Fluorescence; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000097:blood* / Q000235:genetics; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D010265:Paraproteinemias / Q000097:blood; D010266:Paraproteins / Q000378:metabolism*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013937:Thymidine Kinase / Q000097:blood; D051746:ZAP-70 Protein-Tyrosine Kinase / Q000097:blood
chemical_list: D007074:Immunoglobulin G; D007143:Immunoglobulin Heavy Chains; D010266:Paraproteins; D013937:Thymidine Kinase; C092717:thymidine kinase 1; D051746:ZAP-70 Protein-Tyrosine Kinase; C497261:ZAP70 protein, human; D051997:ADP-ribosyl Cyclase 1