Diffuse large B-cell lymphoma with continuously elevated immunoglobulin M following treatment: a case report with pathologic, immunophenotypic, and molecular analyses
A rare subtype of diffuse large B-cell lymphoma (DLBCL) has been reported to be accompanied by elevated immunoglobulin M (IgM) paraprotein in the serum at diagnosis, called as IgMs-DLBCL. The monoclonal IgM paraprotein disappears soon after treatment in most of these patients. Here, we described a D...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
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Frontiers Media S.A.
2023-11-01
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| Series: | Frontiers in Genetics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fgene.2023.1228372/full |
| _version_ | 1797635553554857984 |
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| author | Fei Xiao Yong-Mei Cai Jian-Chen Fang Yan-Ying Shen Bao-Hua Yu Yi-Wei Zhang Di Zhu Zi-Hua Li Guo-Qing Li Jian Hou Min-Yue Zhang Hong-Hui Huang |
| author_facet | Fei Xiao Yong-Mei Cai Jian-Chen Fang Yan-Ying Shen Bao-Hua Yu Yi-Wei Zhang Di Zhu Zi-Hua Li Guo-Qing Li Jian Hou Min-Yue Zhang Hong-Hui Huang |
| author_sort | Fei Xiao |
| collection | DOAJ |
| description | A rare subtype of diffuse large B-cell lymphoma (DLBCL) has been reported to be accompanied by elevated immunoglobulin M (IgM) paraprotein in the serum at diagnosis, called as IgMs-DLBCL. The monoclonal IgM paraprotein disappears soon after treatment in most of these patients. Here, we described a DLBCL patient with continuously elevated IgM following therapy. A 59-year-old male was diagnosed with DLBCL (GCB subtype per Hans algorithm, stage IA) with involvement of the right cervical lymph node. After six cycles of immuno-chemotherapy with the R-CHOP regimen, complete metabolic remission was achieved, but an elevated level of serum IgM persisted. To investigate the origin of elevated IgM, pathologic, immunophenotypic, and molecular analyses of lymph node and bone marrow (BM) samples were performed pre- and post-treatment. BM infiltration of lymphoplasmacytic cells, and a typical immunophenotypic profile by flow cytometry supported the diagnosis of Waldenström macroglobulinemia (WM). The MCD subtype of DLBCL was identified by next-generation sequencing of the lymph node at initial diagnosis characterized by co-occurring point mutations in MYD88L265P and CD79B. Additionally, two different dominant clonotypes of the immunoglobulin heavy chain (IGH) were detected in the lymph node and BM by IGH sequencing, which was IGHV 3–11*06/IGHJ 3*02 and IGHV 3–11*06/IGHJ 6*02, respectively, speculating to be two independent clonal origins. This study will provide a panoramic understanding of the origin or biological characteristics of DLBCL co-occurring with WM. |
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| format | Article |
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| institution | Directory Open Access Journal |
| issn | 1664-8021 |
| language | English |
| last_indexed | 2024-03-11T12:23:24Z |
| publishDate | 2023-11-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Genetics |
| spelling | doaj.art-105c5567f20746f69424b6ee40b1bd642023-11-06T15:52:44ZengFrontiers Media S.A.Frontiers in Genetics1664-80212023-11-011410.3389/fgene.2023.12283721228372Diffuse large B-cell lymphoma with continuously elevated immunoglobulin M following treatment: a case report with pathologic, immunophenotypic, and molecular analysesFei Xiao0Yong-Mei Cai1Jian-Chen Fang2Yan-Ying Shen3Bao-Hua Yu4Yi-Wei Zhang5Di Zhu6Zi-Hua Li7Guo-Qing Li8Jian Hou9Min-Yue Zhang10Hong-Hui Huang11Department of Hematology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Hematology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Pathology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Pathology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Pathology, Fudan University Shanghai Cancer Center, Shanghai, ChinaDepartment of Hematology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Hematology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Hematology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaShanghai Rightongene Biomedical Technology Co., Ltd., Shanghai, ChinaDepartment of Hematology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Hematology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Hematology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaA rare subtype of diffuse large B-cell lymphoma (DLBCL) has been reported to be accompanied by elevated immunoglobulin M (IgM) paraprotein in the serum at diagnosis, called as IgMs-DLBCL. The monoclonal IgM paraprotein disappears soon after treatment in most of these patients. Here, we described a DLBCL patient with continuously elevated IgM following therapy. A 59-year-old male was diagnosed with DLBCL (GCB subtype per Hans algorithm, stage IA) with involvement of the right cervical lymph node. After six cycles of immuno-chemotherapy with the R-CHOP regimen, complete metabolic remission was achieved, but an elevated level of serum IgM persisted. To investigate the origin of elevated IgM, pathologic, immunophenotypic, and molecular analyses of lymph node and bone marrow (BM) samples were performed pre- and post-treatment. BM infiltration of lymphoplasmacytic cells, and a typical immunophenotypic profile by flow cytometry supported the diagnosis of Waldenström macroglobulinemia (WM). The MCD subtype of DLBCL was identified by next-generation sequencing of the lymph node at initial diagnosis characterized by co-occurring point mutations in MYD88L265P and CD79B. Additionally, two different dominant clonotypes of the immunoglobulin heavy chain (IGH) were detected in the lymph node and BM by IGH sequencing, which was IGHV 3–11*06/IGHJ 3*02 and IGHV 3–11*06/IGHJ 6*02, respectively, speculating to be two independent clonal origins. This study will provide a panoramic understanding of the origin or biological characteristics of DLBCL co-occurring with WM.https://www.frontiersin.org/articles/10.3389/fgene.2023.1228372/fulldiffuse large B-cell lymphomaWaldenström macroglobulinemiaimmunoglobulin Mimmunoglobulin heavy-chain sequencingMYD88 mutation |
| spellingShingle | Fei Xiao Yong-Mei Cai Jian-Chen Fang Yan-Ying Shen Bao-Hua Yu Yi-Wei Zhang Di Zhu Zi-Hua Li Guo-Qing Li Jian Hou Min-Yue Zhang Hong-Hui Huang Diffuse large B-cell lymphoma with continuously elevated immunoglobulin M following treatment: a case report with pathologic, immunophenotypic, and molecular analyses Frontiers in Genetics diffuse large B-cell lymphoma Waldenström macroglobulinemia immunoglobulin M immunoglobulin heavy-chain sequencing MYD88 mutation |
| title | Diffuse large B-cell lymphoma with continuously elevated immunoglobulin M following treatment: a case report with pathologic, immunophenotypic, and molecular analyses |
| title_full | Diffuse large B-cell lymphoma with continuously elevated immunoglobulin M following treatment: a case report with pathologic, immunophenotypic, and molecular analyses |
| title_fullStr | Diffuse large B-cell lymphoma with continuously elevated immunoglobulin M following treatment: a case report with pathologic, immunophenotypic, and molecular analyses |
| title_full_unstemmed | Diffuse large B-cell lymphoma with continuously elevated immunoglobulin M following treatment: a case report with pathologic, immunophenotypic, and molecular analyses |
| title_short | Diffuse large B-cell lymphoma with continuously elevated immunoglobulin M following treatment: a case report with pathologic, immunophenotypic, and molecular analyses |
| title_sort | diffuse large b cell lymphoma with continuously elevated immunoglobulin m following treatment a case report with pathologic immunophenotypic and molecular analyses |
| topic | diffuse large B-cell lymphoma Waldenström macroglobulinemia immunoglobulin M immunoglobulin heavy-chain sequencing MYD88 mutation |
| url | https://www.frontiersin.org/articles/10.3389/fgene.2023.1228372/full |
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