[The prognostic value of IGHV gene segment usage in advanced-stage follicular lymphoma with bone marrow infiltration].

Objective: To investigate the prognostic value of immunoglobulin heavy chain variable region (IGHV) gene segment usage characteristics in high-risk follicular lymphoma (FL) patients with bone marrow infiltration. Methods: The clinical data of 33 patients of FL with bone marrow infiltration diagnosed at Jiangsu Province Hospital from August 2017 to November 2024 were collected and retrospectively analyzed. Results: Among the 33 enrolled FL patients, 32 (97.0% ) had mutated IGHV, with a median germline identity of 90.7%. The IGHV3 family was predominant (23 cases, 69.7% ), with IGHV3-48 (9 cases, 27.3% ), IGHV3-23 (4 cases, 12.1% ), and IGHV3-66 (4 cases, 12.1% ) as the most frequent segments. Consistent with prior reports, the frequency of IGHV3-48 usage in our cohort (27.3% ) was higher than that observed in other B-cell lymphomas, including chronic lymphocytic leukemia (3.8% ), splenic marginal zone lymphoma (0), and Waldenström macroglobulinemia (2.2% ) (all P value<0.05). Univariate analysis showed that FL patients using the IGHV3-48 gene exhibited higher lactate dehydrogenase levels (66.7% vs 13.6% ; OR=12.7, 95% CI: 1.6-102.3, P=0.017) and a higher proportion of FLIPI-2 score ≥3 (88.9% vs 33.3% ; OR=15.0, 95% CI: 1.6-142.2, P=0.018). Furthermore, patients using the IGHV3-48 gene segment also demonstrated a trend toward an increased risk of disease progression within 12 months (POD12) (44.4% vs 12.5% ; OR=4.8, 95% CI: 0.8-28.9, P=0.087) . Conclusion: The usage of the IGHV3-48 gene may have certain reference value for early prognostic prediction in FL patients with bone marrow infiltration.