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  • 1.
    Ahlgren, Camilla
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Ahnlide, Ingela
    Malmö högskola, Faculty of Odontology (OD).
    Björkner, Bert
    Malmö högskola, Faculty of Odontology (OD).
    Bruze, Magnus
    Malmö högskola, Faculty of Odontology (OD).
    Liedholm, Rolf
    Malmö högskola, Faculty of Odontology (OD).
    Möller, Halvor
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Krister
    Malmö högskola, Faculty of Odontology (OD).
    Contact allergy to gold is correlated to dental gold.2002In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 82, no 1, p. 41-4Article in journal (Refereed)
    Abstract [en]

    Questionnaire studies have indicated that patients with dental gold will more frequently have contact allergy to gold. This study aimed at investigating the relationship between contact allergy to gold and the presence and amount of dental gold alloys. A total of 102 patients were referred for patch testing because of suspicion of contact allergy. Patch tests were performed with gold sodium thiosulphate 2% and 5%. The patients underwent an oral clinical and radiological examination. Contact allergy to gold was recorded in 30.4% of the patients, and of these 74.2% had dental gold (p=0.009). A significant correlation was found between the amount of gold surfaces and contact allergy to gold (p=0.008), but there was no statistical relationship to oral lesions. It is concluded that there is a positive relationship between contact allergy to gold and presence and amount of dental gold alloys.

  • 2.
    Ahlgren, Camilla
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Axéll, Tony
    Möller, Halvor
    Isaksson, Marléne
    Liedholm, Rolf
    Malmö högskola, Faculty of Odontology (OD).
    Bruze, Magnus
    Contact allergies to potential allergens in patients with oral lichen lesions2014In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 18, no 1, p. 227-237Article in journal (Refereed)
    Abstract [en]

    The aim of the present controlled study was to investigate a possible relationship between contact allergies to potential allergens and oral lichen lesions. Eighty-three patients with oral lichen lesions (OLL) and control groups of age- and gender-matched dermatitis patients (DP, n = 83) and patch-tested dermatitis patients randomly selected from files (PSFF, n = 319) were included in the study. OLL and DP groups were patch-tested epicutaneously and examined intraorally. The frequencies of contact allergy to mercury and carvone were statistically higher in the OLL group than in the DP group. Surfaces of amalgam and composite restorations were statistically more frequent in the OLL group compared to the DP group. Contact allergy to nickel and colophony, the latter with a statistically significant difference, was more common in the DP group. The numerical difference found for nickel allergy was, however, not significant comparing the OLL and PSFF groups. Contact allergy to mercury was overrepresented in patients with OLL and has been reported in previous studies, but the present finding of an overrepresentation of contact allergy to carvone in patients with oral lichen lesions has not been reported previously. Carvone, in addition to mercury and gold, as previously suggested, can be one of the causative or maintenant factors for oral lichen lesions. Carvone-hypersensitive patients with oral lichen lesions should therefore avoid carvone-containing products for oral use.

  • 3.
    Ahlgren, Camilla
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Bruze, Magnus
    Möller, Halvor
    Gruvberger, Birgitta
    Axéll, Tony
    Liedholm, Rolf
    Malmö högskola, Faculty of Odontology (OD).
    Nilner, Krister
    Malmö högskola, Faculty of Odontology (OD).
    Contact Allergy to Gold in Patients with Oral Lichen Lesions2012In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 92, no 2Article in journal (Refereed)
    Abstract [en]

    The aetiology of oral lichen lesions is obscure. In this study the frequency of contact allergy to gold in 83 patients with oral lichen lesions was compared with that in two control groups, comprising 319 age- and gender-matched patients with dermatitis selected from files and 83 clinically examined dermatitis patients. All patients were tested epicutaneously with gold sodium thiosulphate. The two control groups tested were under examination for a tentative diagnosis of allergic dermatitis not related to oral problems. The frequency of contact allergy to gold was 28.9% in the patients with oral lichen lesions, 18.2% in patients selected from files, and 22.9% in the clinically examined control patients. The difference in frequency between patients with oral lichen lesions and those taken from files was statistically significant.

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  • 4.
    Ahlgren, Camilla
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Isaksson, Marlene
    Möller, Halvor
    Axéll, Tony
    Liedholm, Rolf
    Malmö högskola, Faculty of Odontology (OD).
    Bruze, Magnus
    The necessity of a test reading after 1 week to detect late positive patch test reactions in patients with oral lichen lesions2014In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 18, no 5, p. 1525-1531Article in journal (Refereed)
    Abstract [en]

    Establishing the clinical relevance of contact allergy to dental materials in patients with oral lichen lesions (OLL) may be difficult, and tests are often read only on day 3 or day 4; also, concentration of the tested allergens may vary. Several studies on dermatitis patients have shown that additional positive patch test reactions can be found after day 4. Therefore, the aim of the present study was to analyse the frequency of late positive reactions to potential allergens in patients with OLL. Eighty-three of 96 consecutive patients with biopsy-verified OLL were patch-tested with a recently developed lichen series. The patches were removed after 48 h and reactions read 3 and 7 days after application. A total of 129 contact allergies were found, and 26 (20.2 %) of the allergic reactions in 23 patients were seen on day 7 only. The 25.2 % increase in positive test reactions with an additional reading on day 7 in addition to day 3 was statistically significant. Metals were the substances with the highest frequency of late positive reactions. Patients with OLL cannot be considered properly investigated with regard to contact allergy, unless the testing has been performed with mandatory readings on day 3 (or day 4) and day 7. Late patch test readings are crucial in order to elucidate the role of contact allergy to dental materials in the aetiology of OLL.

  • 5.
    Liedholm, Rolf
    Malmö högskola, Faculty of Odontology (OD).
    Mandibular third molar removal: patient preferences, assessments of oral surgeons and patient flows2005Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Mandibular third molar removal is one of the most common treatments conducted at oral andmaxillofacial surgery clinics in Sweden. During the 1980’s and 1990’s, 20-25,000 mandibularthird molars were removed annually which represents about 60% of the total operation volume. Removals performed in private specialist clinics and general dental clinics are not included in these figures. The aims of the present studies on mandibular third molars were to: 1) study values thatreflect patients’ preferences about possible outcomes of removal and non-removal; 2) makecomparisons between Sweden and Wales with respect to patient’s preferences; 3) studyassessments of oral surgeons’ indications for molars to be removed ; 4) describe patient flowsin the care process of removal.The multi-attribute utility (MAU) method was used to quantify patients’ preferences about outcomes following removal and non-removal. Whilst there were clear cultural and economic differences between the Swedish and the Welsh, there was a high degree of correlation in patients’ ranking of the different outcomes for patients from the two countries (rs= 0.93, P<0.001). Generally, situations describing the outcomes of non-removal had a higher ranking than those describing the outcomes of removal i.e. patients seemed to prefer non-removal.Oral surgeons at seven specialist clinics registered data for 666 patients i.e. patient age and sex, the angular position and extent of eruption of the molar and whether or not there was an associated disease related to the molar proposed for removal. The indication for the removal was assessed on a Visual Analogue Scale (VAS), and the recorded results found to show agreat variety. The mean VAS for removal of molars without disease was significantly lowerthan that for molars with associated disease. The differences between the mean VAS formolars with one disease compared with molars with two or three diseases were not significant.The patients´ age was the only factor that had a significant effect on the assessment ofthe indication for molars without disease. The indication was higher for patients of the youngestage group than for patients of the oldest age group (P< 0.05).In four specialist units in southern Sweden, the patient flows (the number of visits and whatthe visits comprise of) was registered for 361 patients. All details were recorded from arrivalof the referral to the unit to performed mandibular third molar surgery. Eight different patient flows were found. The number of patient visits varied from one to three. For about 60 percent of the patients, attached radiographs to the referral were considered not appropriate and had to be completed, e.g. to be retaken. For a minority of the patients, the radiographic examination was completed at the radiological clinic included in the specialist unit and, in the oral and maxillofacial clinic for the others. The number of patient visits seemed not to depend on whether the attached radiographs were judged to be appropriate or not.In conclusion:• Patient preferences seem to be more stable than the preferences of oral surgeons acrossthe boundaries.• Patients prefer outcomes of third molar non-removal as compared to outcomes followingremoval.• Different patient flows may influence the cost-effectiveness in mandibular third molar surgery.

  • 6.
    Liedholm, Rolf
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Henricsson, Vincent
    Department of Oral and Maxillofacial Surgery, Central Hospital, Växjö, Sweden.
    Lysell, Leif
    Department of Oral and Maxillofacial Surgery, Central Hospital, Kristianstad, Sweden.
    Norlund, Anders
    Swedish Council on Technology Assessment in Health Care, Stockholm, Sweden.
    Rohlin, Madeleine
    Malmö högskola, Faculty of Odontology (OD).
    Rosenquist, Bo
    Department of Oral and Maxillofacial Surgery, Lund University Hospital, Lund, Sweden.
    Knutsson, Kerstin
    Malmö högskola, Faculty of Odontology (OD).
    Patient Flows in the Care Process of Mandibular Third Molar Surgery2005In: Swedish Dental Journal, ISSN 0347-9994, Vol. 29, no 3, p. 97-104Article in journal (Other academic)
    Abstract [en]

    Our aim was to describe patient flows in mandibular third molar surgery at oral and maxillofacial specialist units. Our hypothesis was that there are variations in how care is delivered and that the variations could be explained by inter-individual variations in surgeons’ practice, the quality of the radiographs appended to the referral, and the staffing of the specialist units. A flow chart was constructed to simulate all possible patient flows in the care process. The chart begins with treatment planning, which was drawn up based on documents from the referring dentist or another caregiver; continues with the care process at the oral and maxillofacial surgery unit, including surgical consultations and radiological examinations; and ends with surgery. Surgeons at four oral and maxillofacial surgery units in the National Health Service in southern Sweden participated. The intention was to collect data on at least 100 patients who had undergone mandibular third molar surgery at each unit. Data on 361 patients were collected. The radiographs appended to the referral were judged to be inappropriate for the majority of the patients (61%). For 13% of these patients, supplementary radiographic examinations were made at the radiology clinic included in the unit, whilst 48% were examined at the oral and maxillofacial surgery clinic. There were eight different patient flow patterns. In one unit with three surgeons, eight different flow patterns were recorded, indicating an interindividual variation among the surgeons. In a second unit, six different flow patterns were recorded. In the last two units, the patient flows appeared to be the same at each unit, although the predominant patient flows in these two units differed. The number of patient visits to the specialist units ranged between one and three. In three specialist units, most patients were called twice whilst in one specialist unit most patients were called only once, to have the third molar removed. Differences existed in the care process. Overall, the number of patient visits seemed not to depend on whether the preoperative radiographic examination was judged to be appropriate or whether the additional radiographs were made at the radiology clinic.

  • 7.
    Liedholm, Rolf
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Knutsson, Kerstin
    Malmö högskola, Faculty of Odontology (OD).
    Visdomstanden - ska den tas bort?2007Conference paper (Other (popular science, discussion, etc.))
  • 8.
    Liedholm, Rolf
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Knutsson, Kerstin
    Malmö högskola, Faculty of Odontology (OD).
    Lysell, L
    Department of Oral Surgery, Central Hospital, Kristianstad.
    Rohlin, Madeleine
    Malmö högskola, Faculty of Odontology (OD).
    Mandibular third molars: oral surgeons' assessment of the indications for removal1999In: British Journal of Oral & Maxillofacial Surgery, ISSN 0266-4356, E-ISSN 1532-1940, Vol. 37, no 6, p. 440-443Article in journal (Refereed)
    Abstract [en]

    The aim was to examine oral surgeons' assessment of the indications for removal of mandibular third molars. Questionnaires were distributed to seven oral and maxillofacial surgery clinics. The oral surgeons were asked to record whether or not there was associated disease. Three other factors were recorded: patient's age, and angular position and extent of eruption of the molars. The strength of the indication for removal was rated on a visual analogue scale (VAS) where 0 = weakest and 100 = strongest indication for removal. The results were based on data from 666 molars: 118 (18%) had no disease, 465 (70%) had one associated disease, 77 (11%) had two and 6 (1%) had three. The indication for removal as expressed by the mean VAS for molars with no disease was assessed to be weaker (P < 0.05) than that for molars with one, two, or three diseases. The only; factor that influenced the indication for removal in molars with no disease was the patient's age.

  • 9.
    Liedholm, Rolf
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Knutsson, Kerstin
    Malmö högskola, Faculty of Odontology (OD).
    Lysell, Leif
    Rohlin, Madeleine
    Malmö högskola, Faculty of Odontology (OD).
    Brickley, Mark
    Shepherd, Jonathan P
    The outcomes of mandibular third molar removal and non-removal: a study of patients' preferences using a multi-attribute method2000In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 58, no 6, p. 293-298Article in journal (Refereed)
    Abstract [en]

    The aim was to study patients' preferences about outcomes of mandibular third molar removal and non-removal using multi-attribute utility (MAU) methodology. The study comprised three stages. Stage 1: Elicitation of domains, i.e. main areas of patients' lives which could be affected by third molar removal and non-removal. Stage 2a: Interdomain weighting was obtained by relative weighting of the domains elicited in Stage 1. Stage 2b: Intradomain weighting obtained by patients' designation of values for different health slates of each domain. Stage 3: Rating of outcomes. The patients were asked to imagine experiencing a variety of outcomes of mandibular third molar removal and non-removal, described in 19 short vignettes. The numbers of patients interviewed for the three stages were 30, 78, and 55, respectively. Five domains were identified. The mean relative weightings were approximately equal for the domains "Home and social life" and "General health and well-being", followed in order of importance by "Job and studies" and "Health and comfort of mouth, teeth and gums". "Your appearance" received the lowest mean relative weighting. The vignette, which described the presence of a fluid-filled sac and suggested that this tooth must be removed, received the highest mean preference (least effect on patients' lives). The lowest mean preference (most effect on patients' lives) was generated by the vignette, which stated that the jaw was broken and that the teeth must be wired together for 6 weeks. We conclude that, from the patient's perspective, outcomes of non-removal were preferable to outcomes of mandibular third molar removal.

  • 10.
    Liedholm, Rolf
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Knutsson, Kerstin
    Malmö högskola, Faculty of Odontology (OD).
    Norlund, Anders
    Economic aspects of mandibular third molar surgery2010In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 68, no 1, p. 43-48Article in journal (Refereed)
    Abstract [en]

    Objective. The aim of this study was to make estimates from a dental care and societal perspective on costs of mandibular third molar surgery. Material and methods. A total of 64 patients were recruited from three Swedish oral and maxillofacial specialist clinics. Calculations were made prospectively on utilization of labor time, specific medical services and materials, and standardized utilization of other direct costs. Indirect costs were identified from patient surveys. Results. The base case average direct cost of surgery was 217 Euro. Adding the patient's average cost due to absence from work and transportation of 333 Euro increased overall costs to 550 Euro per patient. About 86% of the patients reported some absence following surgery. Conclusions. The indirect costs were on average higher than the direct costs, i.e. the patient's loss of time caused higher costs than the intervention per se. Appropriate indications for mandibular third molar removal can minimize the risks of complications and individual or societal costs.

  • 11.
    Liedholm, Rolf
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Lysell, Leif
    Rohlin, Madeleine
    Malmö högskola, Faculty of Odontology (OD).
    Knutsson, Kerstin
    Malmö högskola, Faculty of Odontology (OD).
    Brickley, Mark
    Shepherd, Jonathan
    Third molar treatment outcome: a comparison of patients' preferences in Sweden and Wales2005In: British Dental Journal, ISSN 0007-0610, E-ISSN 1476-5373, Vol. 199, no 5, p. 287-291Article in journal (Refereed)
    Abstract [en]

    Aim: To elucidate and compare patients’ outcome preferences with regard to removal and retention of mandibular third molars in Sweden and Wales. Subjects and Method: The subjects comprised patients referred for and scheduled for removal of one or both mandibular third molars in both Sweden and Wales. To study patients’ preferences for outcomes of removal and retention of the mandibular third molar, the Multi-attribute utility (MAU) methodology was applied to these patients. Results: Relative weighting of domains was similar in the two countries. “Home and social life” received the highest relative weighting in Sweden and “General health and well-being” in Wales. “Your appearance” received the lowest relative weighting in Sweden and Wales. In both Sweden and Wales operative jaw fracture was considered to be the outcome with most impact and dentigerous cyst and imbricated incisors the least impact. Outcome ranking was similar in the two countries and operative outcomes were considered by patients to be more detrimental to health than retention outcomes. Conclusions: This European comparison showed that patients’ preferences in Sweden and Wales were similar and that the outcomes of surgery were considered worse after third molar removal than retention. Patient-orientated treatment decisions are less subject to variation than clinician-orientated decisions.

  • 12. Rudin, Å
    et al.
    Eriksson, L
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Liedholm, Rolf
    Malmö högskola, Faculty of Odontology (OD).
    Werner, MU
    PREDICTION OF POSTOPERATIVE PAIN AFTER LOWER THIRD MOLAR SURGERY2008Conference paper (Refereed)
    Abstract [en]

    Introduction Severe acute pain after lower third molar surgery (L3MS) has been reported in 16-20 % of the patients. The objective of the present study was to evaluate the predictive potential of a combination of preoperative psychological and psycho-physiological variables in estimating severity of postoperative pain, following this high volume, out-patient surgical procedure. Methods Following ethical committee approval and informed consent, 40 consecutive patients scheduled for L3MS were studied. Preoperative psychometric indicators of anxiety, depression and vulnerability were evaluated by patient questionnaires. Quantitative sensory testing was performed with a Modular Sensory Analyzer (Somedic AB, Sweden) using a contact thermode applied to the skin. Thermal thresholds and supra-threshold heat pain perception (1 s: 44, 45, 46, 47 and 48°C [VAS]) were evaluated. Standardized surgery was performed (LE) during local anesthesia. Postoperative pain management was with rescue acetaminophen 1 g and ibuprofen 600 mg. The patients were instructed to daily record pain (VAS) at rest, and, during mouth-opening, eating and drinking and requirement of analgesics for 14 days following surgery. Results Thirty-eight patients completed the study. Median duration of surgery was 11 min (range 2-21 min). Eight patients returned to the clinic because of pain. Total rescue doses of acetaminophen and ibuprofen were 13.5 g (6.5-22.2 g [median (IQ range)]) and 7 g (3.9-13.8 g), respectively. Moderate to severe pain (VAS > 30) was reported by 23/38 at rest, 25/38 during mouth-opening, 24/38 during drinking and 29/38 during eating. In a multiple regression model the combination of psychological vulnerability and heat pain perception rendered a predictive model that could account for 20 to 40 % of the variance in postoperative pain during resting and dynamic conditions following L3MS (P = 0.001). Implementation of clinically relevant preoperative screening methods may offer more efficacious pain therapies to pain susceptible individuals undergoing lower third molar surgery.

  • 13.
    Rudin, Åsa
    et al.
    Univ Lund Hosp, Dept Anesthesiol & Intens Care, S-22185 Lund, Sweden.
    Eriksson, Lars
    Malmö högskola, Faculty of Odontology (OD). Malmö Univ Hosp, Malmö, Sweden.
    Liedholm, Rolf
    Malmö högskola, Faculty of Odontology (OD). Malmö Univ Hosp, Malmö, Sweden.
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Werner, Mads U
    Univ Lund Hosp, Dept Oncol, S-22185 Lund, Sweden.
    Prediction of postoperative pain after mandibular third molar surgery2010In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 24, no 2, p. 189-196Article in journal (Refereed)
    Abstract [en]

    Aims: To evaluate the predictive potential of preoperative psychological and psychophysiological variables in estimating severity of postoperative pain following mandibular third molar surgery (MTMS). Methods: Following ethical committee approval and informed consent, 40 consecutive patients scheduled for MTMS were included. Preoperative psychometric indicators of anxiety, depression, and vulnerability were evaluated by patient questionnaires. Thermal thresholds and heat pain perception (1 second phasic stimuli: 44°C to 48°C) were evaluated with quantitative sensory testing techniques. Standardized surgery was performed during local anesthesia. Postoperative pain management was with rescue paracetamol and ibuprofen. The patients were instructed to record each day their pain at rest and during dynamic conditions, and their requirement of analgesics for 14 days following surgery. Results: Thirty-eight patients completed the study. Eight patients were readmitted because of pain. During the postoperative period, one or more episodes of moderate to severe pain (> 30 on a visual analog scale) was reported by 60% (23/38) at rest, 63% (24/38) during mouth-opening, and 73% (28/38) during eating. In a multiple regression model, the combination of psychological vulnerability and heat pain perception rendered a predictive model that could account for 15 to 30% of the variance in postoperative pain during resting and dynamic conditions (P = .03 to .001).Conclusion: Implementation of clinically relevant preoperative screening methods may offer more efficacious postoperative pain therapies to pain-susceptible individuals undergoing mandibular third molar surgery.

  • 14. Theander, Elke
    et al.
    Vasaitis, Lilian
    Baecklund, Eva
    Nordmark, Gunnel
    Warfvinge, Gunnar
    Malmö högskola, Faculty of Odontology (OD).
    Liedholm, Rolf
    Malmö högskola, Faculty of Odontology (OD).
    Brokstad, Karl
    Jonsson, Roland
    Jonsson, Malin V
    Lymphoid organisation in labial salivary gland biopsies is a possible predictor for the development of malignant lymphoma in primary Sjögren's syndrome2011In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 70, no 8, p. 1363-1368Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The development of non-Hodgkin's lymphoma (NHL) confers a high risk of mortality in primary Sjögren's syndrome (pSS) patients, but the sensitivity and specificity of proposed lymphoma predictors are insufficient for practical use. The performance of lymphoid organisation in the form of germinal centre (GC)-like lesions was evaluated in labial salivary gland biopsies taken at pSS diagnosis as a potential lymphoma-predicting biomarker. METHODS: Labial salivary gland tissue biopsies available from two Swedish pSS research cohorts (n=175) were re-evaluated by light microscopy in a blind study in order to identify GC-like structures as a sign of ectopic lymphoid tissue formation and organisation. A linkage study was performed with the Swedish Cancer Registry for lymphoma identification. The risk of developing NHL in GC-positive patients in comparison with GC-negative patients was evaluated using Kaplan-Meier statistics and log-rank test. Associations between GC-like structures and clinical and/or laboratory disease markers were also determined using χ(2) or Fisher's exact tests. RESULTS: At diagnosis, 25% of pSS patients had GC-like structures in their salivary glands. Seven of the 175 patients studied (14% GC+ and 0.8% GC-) developed NHL during 1855 patient-years at risk, with a median onset of 7 years following the initial diagnostic salivary gland biopsy. Six of the seven patients had GC-like structures at diagnosis; the remaining patient was GC negative at the time of diagnosis (p=0.001). CONCLUSIONS: The detection of GC-like structures by light microscopy in pSS diagnostic salivary biopsies is proposed as a highly predictive and easy-to-obtain marker for NHL development. This allows for risk stratification of patients and the possibility to initiate preventive B-cell-directed therapy.

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