Role of serum free light chains in predicting HIV-associated non-Hodgkin lymphoma and Hodgkin's lymphoma and its correlation with antiretroviral therapy.
A nested case-control study was performed within the Italian cohort of naïve to antiretroviral human immunodeficiency virus (HIV) patients (ICONA) cohort to evaluate the role of serum free light chains (sFLC) in predicting non-Hodgkin's lymphoma (NHL) and Hodgkin lymphoma (HL) in HIV-infected individuals. Of 6513 participants, 86 patients developed lymphoma and 46 of these (NHL, 30; HL, 16) were included in this analysis having stored prediagnostic blood. A total of 46 serum case samples matched 1:1 to lymphoma-free serum control samples were assayed for κ and λ sFLC levels and compared by using conditional logistic regression. Because the polyclonal nature of free light chains (FLCs) was the focus of our study, we introduced the k + λ sum as the measurement of choice and as the primary variable studied. κ + λ sFLC values were significantly higher in patient with lymphoma than in controls, especially when considering samples stored 0-2-year period before the lymphoma diagnosis. In the multivariable analysis, the elevation of sFLC predicted the risk of lymphoma independently of CD4 count, (odd ratio of 16.85 for k + λ sFLC >2-fold upper normal limit (UNL) vs. normal value). A significant reduction in the risk of lymphoma (odd ratio of 0.07 in model with k + λ sFLC) was found in people with low sFLC and undetectable HIV viremia lasting more than 6 months. Our analysis indicates that an elevated polyclonal sFLC is a strong and sensitive predictor of the risk of developing lymphomas, and it is an easy to measure biomarker that merits consideration for introduction in routine clinical practice in people with HIV.
National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy. michele.bibas@inmi.it
Michele
M
Bibas
Maria Paola
MP
Trotta
Alessandro
A
Cozzi-Lepri
Patrizia
P
Lorenzini
Carmela
C
Pinnetti
Giuliano
G
Rizzardini
Gioacchino
G
Angarano
Pietro
P
Caramello
Laura
L
Sighinolfi
Claudio Maria
CM
Mastroianni
Giovanni
G
Mazzarello
Antonino
A
Di Caro
Cristina
C
Di Giacomo
Antonella
A
d'Arminio Monforte
Andrea
A
Antinori
D000328:Adult; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D006689:Hodgkin Disease / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007145:Immunoglobulin kappa-Chains / Q000097:blood*; D007146:Immunoglobulin lambda-Chains / Q000097:blood*; D008228:Lymphoma, Non-Hodgkin / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
D007145:Immunoglobulin kappa-Chains; D007146:Immunoglobulin lambda-Chains