Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

The FMS-Like Tyrosine Kinase3-Ligand (FL) Is a Marker for Lymphoma in Primary Sjgren's Syndrome (SS).

Pers1,  Jacques-Olivier, Tobon1,  Gabriel J., Gottenberg7,  Jacques E., Seror4,  Raphaèle, Devauchelle2,  Valérie, Morel5,  Jacques, Rist6,  Stéphanie

Brest University, Brest, France
Brest University
CHU de la Cavale Blanche, Brest Cedex, France
Le Kremlin Bicetre Hospital
Montpellier University
Orleans Hospital
Strasbourg Hospitals, Strasbourg, France


The exocrine glands of patients with primary SS become sites of intense immunological activity and thereby present with tissue damage. Salivary glands exhibit a lymphoproliferative sialadenitis, associates with lymphocyte infiltration and epithelial cell apoptosis. Compared with healthy individuals, patients with SS are at greater risk of developing non-Hodgkin's lymphoma. We recently published that FL, a cytokine implicated in B-cell ontogenesis and malignant proliferation, might unveil primary SS at risk of developing lymphoma (Tobón et al., Arthritis Rheum. 2010).


In order to confirm this observation, serum levels of FL were measured in 334 patients enrolled in the French cohort of primary SS patients. All fulfilled the European American criteria for SS. Association between FL positivity and: 1- criteria linked to a high risk of lymphoma such as purpura, low C4 levels, enlargement of the parotid glands, monoclonal Ig, cryoglobulinemia; 2- lymphoma development; 3- disease activity according to visual analogic score (VAS) for subjective signs and the EULAR SS Disease Activity Index (ESSDAI).

120 pg/mL of FL was considered as positive (FL+) i.e. 2 SD above the mean of 50 controls. Nevertheless, sensitivity and specificity were calculated at different cut-off values. To compare data FL+ and FL-, we used the chi-square or Fisher exact test for qualitative variables and the Mann-Whitney test for quantitative variables (Statistical Package for the Social Sciences).


Main results are listed in the Table. FL+ patients were younger. The sex ratio, subjective symptoms of dryness and parotidomegaly were not statistically associated to FL. In contrast, purpura and lymphoma, as well as ESSDAI were significantly associated with elevated levels of FL. ROC analysis showed that 175 pg/mL was ideal cut-off to detect the association with lymphoma: sensitivity 44%, specificity 97.5%.

Age (years)56.5962.58 (P<0.0001)
Sex M/F5/9417/240
Purpura16/921/235 (P<0.01)
History of lymphoma13/945/240 (P<0.0001)
VAS sicca5.125.45
VAS pain4.714.82
VAS fatigue5.946.01
ESSDAI6.685.33 (P<0.05)


FL is elevated and correlated with history or presence of lymphoma in primary SS 334 patients. The role of FL in B cell proliferation may explain the clinical evolution to B cell lymphoma in some patients and targeting FL open new therapeutic options.

To cite this abstract, please use the following information:
Pers, Jacques-Olivier, Tobon, Gabriel J., Gottenberg, Jacques E., Seror, Raphaèle, Devauchelle, Valérie, Morel, Jacques, et al; The FMS-Like Tyrosine Kinase3-Ligand (FL) Is a Marker for Lymphoma in Primary Sjgren's Syndrome (SS). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1914
DOI: 10.1002/art.29679

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