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Genetic Polymorphisms in the Tumor Necrosis Factor Locus Influence
Non-Hodgkin's Lymphoma Outcome
Krzysztof Warzocha,
Patricia Ribeiro,
Jacques Bienvenu,
Pascal Roy,
Carole Charlot,
Dominique Rigal,
Bertrand Coiffier, and
Gilles Salles
From the Department of Hématologie, Laboratoire d'Immunologie
and Unité de Méthodologie en Cancérologie,
Université Claude Bernard (UPRES-JE 1879), and the Centre
Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite,
France; and the Etablissement de Transfusion Sanguine, Lyon, France.
Systemic release of tumor necrosis factor (TNF) and lymphotoxin-
(LT ) has been found to contribute to the severity of non-Hodgkin's lymphoma (NHL). We investigated whether genetic polymorphisms in the
TNF locus, previously shown to influence TNF and LT genes expression, might contribute to these cytokines production and to the
clinical course of NHL. Genomic DNA from 273 lymphoma patients was
typed for TNF ( 308) polymorphism using an allele-specific polymerase
chain reaction (PCR) and for LT (+252) polymorphism with a
PCR-based restriction fragment length polymorphism. The presence of the
TNF allele involved in increased TNF gene transcription was associated
with higher plasma levels of this cytokine at the time of lymphoma
diagnosis ( 2 test, P = .013). An extended
haplotype analysis showed that the presence of at least two TNF or
LT high-producer alleles constituted a risk factor for first-line
treatment failure ( 2 test, P = .021), shorter
progression-free survival (log-rank test, P = .0007), and
overall survival (log-rank test, P = .012). In the subgroup
of 126 patients with diffuse large-cell lymphoma, the presence of two
or more TNF/LT high producing alleles contributed significantly to a
higher rate of relapse and progression (log-rank test, P = .045 and P = .027). In multivariate Cox regression models including the variables of the International Prognostic Index, the
TNF/LT haplotype status was found to be an independent risk factor
for progression-free survival (relative risk 2.33, 95% confidence
interval [1.17 to 4.64], P = .0053) and overall survival (relative risk 1.92, 95% confidence interval [0.63 to 5.80],
P = .081) of large-cell lymphoma patients. These results
indicate that genetic polymorphism leading to increased TNF production influences the outcome of NHL and suggest a pathophysiological role for
the genetic control of the immune response in lymphoid malignancies.
Blood, Vol. 91 No. 10 (May 15), 1998:
pp. 3574-3581
© 1998 by The American Society of Hematology.

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