Oligoclonal non-neoplastic B cell expansion is the key feature of type II mixed cryoglobulinemia: Clinical and molecular findings do not support a bone marrow pathologic diagnosis of indolent B cell lymphoma

Salvatore De Vita, Valli De Re, Daniela Gasparotto, Marco Ballarè, Barbara Pivetta, Gianfranco Ferraccioli, Stefano Pileri, Mauro Boiocchi, Angelo Monteverde

Research output: Contribution to journalArticle

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Abstract

Objective. Type II mixed cryoglobulinemia (type II MC) is often characterized by features of indolent B cell lymphoma (IBCL) found on pathologic examination of bone marrow, whereas the clinical evidence does not indicate a neoplastic disorder. To better address the issue of indolent malignant versus nonmalignant bone marrow lymphoproliferation underlying type II MC, molecular analyses of B cell clonality were performed in the present study, in conjunction with clinical and pathologic characterization. Methods. Polymerase chain reaction DNA amplification of immunoglobulin heavy chain genes was performed in bone marrow biopsy specimens obtained from 15 selected patients with type II MC, all infected with hepatitis C virus. Five of them had also developed overt B cell lymphoma (OBCL) during followup. Bone marrow features were consistent with IBCL in 9 of the 15 patients (group 1) and with reactive lymphoplasmacytosis in 6 of the 15 (group 2). Results. An oligoclonal B cell expansion was detected in 6 of 9 baseline bone marrow lesions from group 1 patients (biclonal or monoclonal expansion in the remaining 3 cases), and in 6 of 6 from group 2 patients. OBCL was always monoclonal. Selected lesions were analyzed by clonospecific hybridization and by cloning and sequence analysis in patients who had developed OBCL at followup. In 4 of 5 cases, OBCL did not originate from the dominant B cell clones that were overexpanded in the putative neoplastic baseline bone marrow lesions. OBCL clones showed significant homology with rheumatoid factor database sequences. Conclusion. Based on the present results, as well as on evidence from previous studies of liver lesions, oligoclonal non-neoplastic B cell proliferation in the course of chronic infection-related inflammation appears to be the key feature of type II MC. Of note, molecular evidence from target tissues supports the clinical findings both at the time of type II MC diagnosis and in cases of OBCL complication. Bone marrow pathologic findings resembling those of IBCL should thus be considered in the light of clinical and molecular evidence.

Original languageEnglish
Pages (from-to)94-102
Number of pages9
JournalArthritis and Rheumatism
Volume43
Issue number1
DOIs
Publication statusPublished - Jan 2000

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Cryoglobulinemia
B-Cell Lymphoma
B-Lymphocytes
Bone Marrow
Clone Cells
Immunoglobulin Heavy Chain Genes
Bone Marrow Examination
Rheumatoid Factor
Hepacivirus
Sequence Analysis
Organism Cloning
Cell Proliferation
Databases
Inflammation
Biopsy
Polymerase Chain Reaction

ASJC Scopus subject areas

  • Immunology
  • Rheumatology

Cite this

Oligoclonal non-neoplastic B cell expansion is the key feature of type II mixed cryoglobulinemia : Clinical and molecular findings do not support a bone marrow pathologic diagnosis of indolent B cell lymphoma. / De Vita, Salvatore; De Re, Valli; Gasparotto, Daniela; Ballarè, Marco; Pivetta, Barbara; Ferraccioli, Gianfranco; Pileri, Stefano; Boiocchi, Mauro; Monteverde, Angelo.

In: Arthritis and Rheumatism, Vol. 43, No. 1, 01.2000, p. 94-102.

Research output: Contribution to journalArticle

De Vita, Salvatore ; De Re, Valli ; Gasparotto, Daniela ; Ballarè, Marco ; Pivetta, Barbara ; Ferraccioli, Gianfranco ; Pileri, Stefano ; Boiocchi, Mauro ; Monteverde, Angelo. / Oligoclonal non-neoplastic B cell expansion is the key feature of type II mixed cryoglobulinemia : Clinical and molecular findings do not support a bone marrow pathologic diagnosis of indolent B cell lymphoma. In: Arthritis and Rheumatism. 2000 ; Vol. 43, No. 1. pp. 94-102.
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abstract = "Objective. Type II mixed cryoglobulinemia (type II MC) is often characterized by features of indolent B cell lymphoma (IBCL) found on pathologic examination of bone marrow, whereas the clinical evidence does not indicate a neoplastic disorder. To better address the issue of indolent malignant versus nonmalignant bone marrow lymphoproliferation underlying type II MC, molecular analyses of B cell clonality were performed in the present study, in conjunction with clinical and pathologic characterization. Methods. Polymerase chain reaction DNA amplification of immunoglobulin heavy chain genes was performed in bone marrow biopsy specimens obtained from 15 selected patients with type II MC, all infected with hepatitis C virus. Five of them had also developed overt B cell lymphoma (OBCL) during followup. Bone marrow features were consistent with IBCL in 9 of the 15 patients (group 1) and with reactive lymphoplasmacytosis in 6 of the 15 (group 2). Results. An oligoclonal B cell expansion was detected in 6 of 9 baseline bone marrow lesions from group 1 patients (biclonal or monoclonal expansion in the remaining 3 cases), and in 6 of 6 from group 2 patients. OBCL was always monoclonal. Selected lesions were analyzed by clonospecific hybridization and by cloning and sequence analysis in patients who had developed OBCL at followup. In 4 of 5 cases, OBCL did not originate from the dominant B cell clones that were overexpanded in the putative neoplastic baseline bone marrow lesions. OBCL clones showed significant homology with rheumatoid factor database sequences. Conclusion. Based on the present results, as well as on evidence from previous studies of liver lesions, oligoclonal non-neoplastic B cell proliferation in the course of chronic infection-related inflammation appears to be the key feature of type II MC. Of note, molecular evidence from target tissues supports the clinical findings both at the time of type II MC diagnosis and in cases of OBCL complication. Bone marrow pathologic findings resembling those of IBCL should thus be considered in the light of clinical and molecular evidence.",
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AU - De Re, Valli

AU - Gasparotto, Daniela

AU - Ballarè, Marco

AU - Pivetta, Barbara

AU - Ferraccioli, Gianfranco

AU - Pileri, Stefano

AU - Boiocchi, Mauro

AU - Monteverde, Angelo

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N2 - Objective. Type II mixed cryoglobulinemia (type II MC) is often characterized by features of indolent B cell lymphoma (IBCL) found on pathologic examination of bone marrow, whereas the clinical evidence does not indicate a neoplastic disorder. To better address the issue of indolent malignant versus nonmalignant bone marrow lymphoproliferation underlying type II MC, molecular analyses of B cell clonality were performed in the present study, in conjunction with clinical and pathologic characterization. Methods. Polymerase chain reaction DNA amplification of immunoglobulin heavy chain genes was performed in bone marrow biopsy specimens obtained from 15 selected patients with type II MC, all infected with hepatitis C virus. Five of them had also developed overt B cell lymphoma (OBCL) during followup. Bone marrow features were consistent with IBCL in 9 of the 15 patients (group 1) and with reactive lymphoplasmacytosis in 6 of the 15 (group 2). Results. An oligoclonal B cell expansion was detected in 6 of 9 baseline bone marrow lesions from group 1 patients (biclonal or monoclonal expansion in the remaining 3 cases), and in 6 of 6 from group 2 patients. OBCL was always monoclonal. Selected lesions were analyzed by clonospecific hybridization and by cloning and sequence analysis in patients who had developed OBCL at followup. In 4 of 5 cases, OBCL did not originate from the dominant B cell clones that were overexpanded in the putative neoplastic baseline bone marrow lesions. OBCL clones showed significant homology with rheumatoid factor database sequences. Conclusion. Based on the present results, as well as on evidence from previous studies of liver lesions, oligoclonal non-neoplastic B cell proliferation in the course of chronic infection-related inflammation appears to be the key feature of type II MC. Of note, molecular evidence from target tissues supports the clinical findings both at the time of type II MC diagnosis and in cases of OBCL complication. Bone marrow pathologic findings resembling those of IBCL should thus be considered in the light of clinical and molecular evidence.

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