Monoclonal Immunoglobulin Production Is a Frequent Event in Patients with Mucosa-Associated Lymphoid Tissue Lymphoma

Abstract

Purpose: Mucosa-associated lymphoid tissue (MALT) lymphoma comprises 7% of all newly diagnosed nonHodgkin's lymphomas and is therefore among the most common lymphoma entities. Monoclonal gammopathy due to production of a monoclonal immunoglobulin by lymphoma cells is a well-known phenomenon associated with various types of B-cell non-Hodgkin's lymphomas. The objective of the present study was to evaluate the incidence and clinical relevance of paraprotein (PP) production in patients with MALT lymphoma.Experimental Design: Fifty two patients were prospectively evaluated with regard to differentiation of the MALT lymphoma cells, t(11;18) translocation, monoclonal immunoglobulin production, Helicobacter pylori (HP) status, stage, treatment, and clinical outcome.Results: Nineteen of 52 MALT lymphoma patients (36%) had PP (8 IgM, 6 IgG, 4 IgM, and 1 IgA). The histologic feature of plasmacytic differentiation correlated significantly with the production of PP (P ‫؍‬ 0.001). No correlation was found between PP and clinical stage, HP status, and t(11;18) status. PP was, however, negatively associated with response to eradication of HP in gastric MALT lymphoma, and PP levels declined significantly in patients responding to chemotherapy or radiation. Importantly, both immunofixation and serum electrophoresis have to be performed to detect low PP levels.Conclusions: In conclusion, PP levels may probably be used as a potential prognostic tool for response to HP eradication, and serial measurements may also allow for noninvasive assessment of response to radiation or chemotherapy in patients with MALT lymphoma.

A phase II study of bortezomib in patients with MALT lymphoma

“…According to the current notion, MALT lymphoma arises from marginal zone B-cell cells, which are thought to be related to plasma cells. 13 In fact, up to 30% of patients with MALT lymphoma show the feature of plasmacytic differentiation, 14 and up to 40% have a detectable monoclonal immunoglobulin produced by lymphoma cells 15 suggesting a potential relationship between MALT lymphoma and multiple myeloma. Based on this rationale, along with the promising activity of bortezomib in various B-cell lymphomas, we have performed a single institution phase II study in order to assess the clinical activity of bortezomib in patients with MALT lymphoma.…”

Non-Hodgkin's Lymphoma of Mucosa-Associated Lymphoid Tissue

“…Surface immunoglobulins that demonstrate light chain restriction are present on MALT lymphoma cells. In a prospective study by Wohrer and colleagues, 19 of 52 (36%) patients with newly diagnosed MALT lymphoma also were found to have a serum monoclonal gammopathy [6]. Plasmacytic differentiation is associated with the production of a paraprotein, correlating in turn with advanced disease, including involvement of lymph nodes and bone marrow [6,7].…”

t(11;18)(q21;q21)-positive Advanced-stage MALT Lymphoma Associated with Monoclonal Gammopathy : Resistance to Rituximab or Rituximab-containing Chemotherapy

“…3,4 These studies reported similar incidences of monoclonal gammopathy determined by immunoelectrophoresis and/or immunofixation, 36% 4 and 27%. 3 These studies, however, did not agree regarding if there was a correlation between this condition and clinical parameters.…”

“…One study did not find any correlation between monoclonal gammopathy and clinical stage, H. pylori infection, or presence of the t(11;18)(q21;q21), although monoclonal Ig levels decreased significantly in patients responding to chemotherapy or radiation. 4 In the second study, all patients with extranodal marginal zone lymphomas and concurrent monoclonal gammopathies had stage IV disease ; there was a strong correlation between bone marrow involvement and the presence of monoclonal Ig. 3 The two cases detailed in this study clearly support the latter report indicating that monoclonal gammopathy correlates with disseminated disease.…”

“…1 MALT lymphoma tissues contain not only "centrocyte-like" cells but also plasmacytoid cells with varying degrees of maturation, 2 which may explain the high incidence of monoclonal gammopathy in this particular subtype of low grade B-cell tumors. 3,4 On the other hand, several cases have been reported to exhibit features overlapping with primary macroglobulinemia, [5][6][7][8][9][10] supporting further that neoplastic cells in MALT lymphomas have the potential to differentiate into Ig-secreting plasma cells.…”