Soluble Cell Adhesion Molecules Quantification in Newly Diagnosed Diffuse Large B-cell Lymphoma Patients: Prognostic Implications and Clinical-biological Associations
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma and shows marked prognostic heterogeneity. Current risk stratification relies mainly on the International Prognostic Index (IPI), which does not incorporate relevant biological variables. Cell adhesion molecules (CAM) are involved in tumor proliferation, survival and dissemination, but their role in DLBCL remains poorly defined. We investigated plasma levels of soluble CAM (sICAM-1, sVCAM-1, sP-selectin and sE-cadherin) at diagnosis and their clinical and prognostic significance. Methods This prospective longitudinal study included 87 newly diagnosed DLBCL patients treated at the University of São Paulo, Brazil, between April 2021 and January 2025. Immunosuppression-related DLBCL and patients previously exposed to corticosteroids, cytoreductive chemotherapy or radiotherapy were excluded. Plasma sCAM levels were measured by sandwich ELISA. Optimal cut-offs for overall survival (OS) and event-free survival (EFS) were determined using maximally selected rank statistics. Associations with clinical features, treatment response, relapse/progression and death were assessed using Wilcoxon, chi-square or Fisher’s exact tests. Results Median age was 63 years, 53% were female, 64% had stage III/IV disease, 47% bulky disease ≥7 cm, 54% B-symptoms and 23% ECOG ≥2. All patients received R-CHOP-like therapy; overall response rate was 84% and complete response (CR) 80%. At a median follow-up of 1.09 years, 2-year OS and EFS were 76% and 74%, respectively. Among all sCAM, only sE-cadherin showed prognostic significance. The optimal OS cut-off was 126.55 ng/mL (p=0.034). Patients with sE-cadherin <126.55 ng/mL had superior 2-year OS compared with those with levels ≥126.55 ng/mL (92% vs 53%; p<0.001), and median OS was not reached versus 2.3 years, respectively. Higher sE-cadherin levels were observed in patients who died (145 vs 102 ng/mL; p=0.015), failed to achieve CR (135 vs 102 ng/mL; p=0.019), or developed progression/relapse (136 vs 101 ng/mL; p=0.016). Levels ≥126.55 ng/mL were also associated with B-symptoms (83% vs 33%; p<0.001), anemia (71% vs 29%; p<0.001), and IPI ≥3 (63% vs 39%; p=0.031). In multivariate analysis, baseline sE-cadherin ≥126.55 ng/mL independently predicted inferior OS (HR 3.51, 95% CI 1.01–11.21; p=0.034). sICAM-1, sVCAM-1 and sP-selectin showed no prognostic impact. Conclusion This study identifies plasma sE-cadherin as a novel independent prognostic biomarker in newly diagnosed DLBCL. Elevated baseline levels were associated with adverse clinical features, lower response to R-CHOP, higher relapse/progression risk and inferior OS, supporting its potential role in risk stratification and as a candidate therapeutic target.
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223105376