合并单克隆免疫球蛋白血症的黏膜相关淋巴组织淋巴瘤临床特征分析

目的 探讨单克隆免疫球蛋白(M蛋白)血症在黏膜相关淋巴组织淋巴瘤(MALToma)中的发生率及患者临床特征.方法 回顾性分析2010年10月至2015年10月接受M蛋白检测的16例住院MALToma患者的临床资料.结果 16例MALToma患者中,6例初诊时合并M蛋白血症.其中4例为男性,中位年龄56岁(25～82岁),肿瘤原发部位多为胃肠道(4例),临床分期多为Ⅰ～Ⅱ期(4例),国际预后指数(IPI)评分多为0～2分(5例).6例合并M蛋白血症的患者中有4例分泌单克隆性IgM(3例为κ轻链,1例为λ轻链),2例分泌单克隆性IgG(均为κ轻链).6例合并M蛋白血症的患者中有4例伴有浆细胞分化(PCD),10例未合并M蛋白血症的患者有1例伴有PCD(P=0.036).此外,3例合并M蛋白血症的患者在获得疾病缓解的同时M蛋白水平均较初诊时明显下降,其中2例降至正常水平.结论 M蛋白血症可能在MALToma患者中较常见,可能与伴有PCD有关,且M蛋白水平的降低可能与临床疗效相关.

Clinical features of mucosa-associated lymphoid tissue lymphoma patients with monoclonal gammopathy

Objective To evaluate the incidence and clinical features of monoclonal gammopatly in patients with mucosa-associated lymphoid tissue lymphoma (MALToma).Methods Clinical data of 16 MALToma patients hospitalized from October 2010 to October 2015 who received monoclonal immunoglobulin (M protein) detection were analyzed retrospectively.Results Among 16 MALToma patients,6 patients (37.5 ％) were positive of serum M protein when they were newly diagnosed including 4 males with the median age 56 years (25-82 years),4 patients were primary gastrointestinal MALToma,4 patients were in clinical stage Ⅰ-Ⅱ,and 5 patients' international prognostic index (IPI) score ranged from 0 to 2.In 6 cases,there were 4 cases of secretory monoclonal IgM (3 cases of κ light chain,1 case of λ light chain),and 2 cases of secretory monoclonal IgG (both κ light chain).The plasmacytic differentiation (PCD) could be found in 4 of 6 MALToma patients with M protein positive,but only in 1 of 10 MALToma patients with M protein negative (P =0.036).M protein levels of 3 patients with M protein positive were reduced obviously when they achieved remission compared with those when they were newly diagnosed,including the levels of 2 cases were decreased to normal range.Conclusions Monoclonal gammopathy may be a common phenomenon in patients with MALToma,which is possibly associated with PCD.The decreased M protein level may be corresponded to a good clinical response.