Micrometastatic bone marrow involvement: detection and prognostic significance

1999 ◽  
Vol 16 (3) ◽  
pp. 154-165 ◽  
Author(s):  
S Braun ◽  
K Pantel
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Involvement ◽  
Prognostic Significance

Prognostic Significance of Bone Marrow Involvement in Hodgkin Lymphoma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5370-5370 ◽  
Author(s):  
Ankit Mangla ◽  
Muhammad Umair Mushtaq ◽  
Rohit Kumar ◽  
Nikki Agarwal ◽  
Sibgha Gull Chaudhary ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Hodgkin Lymphoma ◽  
Bone Marrow Involvement ◽  
Prognostic Significance ◽  
Albumin Level ◽  
Stage Iii ◽  
Inverse Association ◽  
Care Hospital ◽  
Advanced Stage ◽  
Histologic Subtype

Abstract Background: The utility of bone marrow biopsy (BMB) in patients with Hodgkin lymphoma (HL) has been a controversial topic. Clinical stage 4 (CS4) has been shown to be an independent poor prognostic marker and is also included in the International Prognostic Scoring (IPS) index for predicting both progression-free survival (PFS) and overall survival (OS). The current guidelines still recommend performing a BMB in patients with stage IIB (with unfavorable risk factors), III and IV HL, mainly for staging purposes. Though bone marrow involvement (BMI) upstages the HL to stage IV, the prognostic significance of BMI remains unclear. The study was aimed to determine the prognostic significance of BMI in underserved patients with HL and to determine the prognostic importance of other blood parameters. Methods: The study was conducted at John H. Stroger Hospital of Cook County, an inner city tertiary care hospital providing care to the underserved population of Chicago. Charts of 241 patients diagnosed with HL were screened from tumor registry. Patients with incomplete charts were not included in the study. Socio-demographic, clinical and pathologic factors were recorded at the time of diagnosis. For comparative purpose, CS4 disease did not include patients with BMI. Kaplan-Meier and bivariate analyses were performed. Cox regression analyses were conducted to explore predictors of OS and PFS. Hazard ratios (HR) with 95% confidence intervals (CI) were obtained. Results: The study included 192 patients of which 41% were Afro-Americans, 34% were Hispanics and 21% were Caucasians. Median age was 34 years with 25.5% patients being older than 45 years and 68% patients being women. Seventeen percent patients were positive for HIV. Nodular sclerosis was the most common histologic subtype (55%), bulky disease was recorded in 19% patients and 61.5% patients had B-symptoms. CS4 disease was seen in 12% patients while 28% patients were stage III, 47% were stage II and 13% were stage I. Single-site BMB was done in 96% patients. BMB was positive for involvement with HL in 19% patients (n=37). Out of these 37 patients, 84% (n=31) had advanced stage (III & IV) HL. BMI was seen in 5% patients with early-stage HL (stages I-II) and 41% patients with advanced-stage HL. Median IPS score was 2 (range 0-6). Median values for clinical factors were: hemoglobin-11.8 g/dL, platelets 314.5 x103/uL, leukocytes 8.3 x103/uL, neutrophils 6x103/uL, lymphocytes 1.2 x103/uL and albumin 3.7 g/dL. Mean OS was 143 months (95% CI 126-160) with 5-year OS of 89%. Significant correlates of OS included: age 45 years or older (HR 2.83, 95%CI 1.25-6.43, P =0.013), HIV (HR 2.80, 95%CI 1.19-6.61, P =0.019), nodular sclerosistype (HR 0.29, 95%CI 0.12-0.71, P =0.006), CS4 disease (HR 3.05, 95%CI 1.20-7.77, P =0.019), BM positive for involvement with HL (HR 5.76, 95%CI 2.56-12.98, P <0.001), IPS score (HR 1.57, 95%CI 1.20-2.06, P =0.001), hemoglobin <10.5 g/dL (HR 3.57, 95%CI 1.56-8.19, P =0.003), platelets <150 x103/uL (HR 5.32, 95%CI 2.19-12.96, P <0.001) and lymphocytes <0.6 x103/uL (HR 2.97, 95%CI 1.21-7.28, P =0.017). Gender, albumin level, leukocytosis (>15 x103/uL) and relative lymphopenia (<8%) did not have a significant association with OS. When adjusted for CS4 disease, BMI remained an independent predictor of OS (HR 2.17, 95%CI 1.04-4.55, P =0.039). Mean PFS was 105 months (95% CI 97-117) with 5-year PFS of 78%. BMI (HR 2.38, 95%CI 1.21-4.67, P =0.012), albumin level (HR 0.71, 95%CI 0.53-0.94, P =0.017) and albumin-globulin ratio (HR 0.41, 95%CI 0.18-0.93, P =0.032) predicted PFS. None of the other factors had a significant association with PFS. BMI had inverse association with OS (mean OS 97.5 months vs. 164 months, P <0.001; 5-year OS 70% vs. 93.5%, P<0.001) and PFS (mean PFS 74 months vs. 112 months, P = 0.004; 5-year PFS 65% vs. 81%, P=0.030). Conclusion: BMI in HL indicates disseminated disease. Our study shows that BMI in patients with HL has a significant inverse relation with OS and PFS, independent of stage. Our data indicates that in patients with HL important prognostic information can be achieved by demonstrating BMI and it should be considered for inclusion in the IPS score. The rate of BMI is higher in our cohort, for both early and advanced stage HL, when compared with literature and maybe a limitation of our retrospective study. However our results still warrant that long term prospective studies should be designed to explore the prognostic significance of BMI. Disclosures No relevant conflicts of interest to declare.

scholarly journals BONE MARROW IN FOLLICULAR LYMPHOMA PROGNOSIS

2016 ◽  
Vol 15 (3) ◽  
pp. 99-102 ◽  
Author(s):  
N. N. Tupitsyn ◽  
N. A. Falaleeva ◽  
A. V. Mozhenkova ◽  
A. I. Pavlovskaya
Keyword(s):  
Bone Marrow ◽  
Overall Survival ◽  
Follicular Lymphoma ◽  
Histological Study ◽  
Bone Marrow Involvement ◽  
International Prognostic Index ◽  
Prognostic Significance ◽  
Prognostic Index ◽  
Prognostic Role ◽  
Long Time

Background. Bone marrow is the mostfrequent metastatic site in follicular lymphoma, 40-70 % cases. It’s unfovourable prognostic role is stated in the index FLIPI-2 (Follicular Lymphoma International Prognostic Index-2). Objective. To study both prognostic role of bone marrow involvement and it’s relation to erythropoiesis peculiarities in follicular lymphoma was the purpose of this research. Materials and methods. Histological study was performed in 269 follicular lymphoma patients. Erythropoiesis peculiarities were studied in that patients according to standard myelogram analysis. Results. Bone marrow involvement was noted according to trephine biopsy section staining in 37,9 % of follicular lymphoma case (102 from 269). Bone marrow involvement did not influenced the prognosis (overall survival) in all period of observation (p = 0,18). Longterm survival (more than 48 months) was negatively influenced by bone marrow involvement (p = 0,04). Intertrabecular pattern of follicular lymphoma growth in bone marrow was negative prognostic factor (p = 0,02). We noted negative correlation between bone marrow involvement and the elevation of orthochromic normoblasts in bone marrow of patients with follicular lymphoma. In cause of bone marrow such elevation was noted in 67 %, and in the absense of involvement - in 78 % (p = 0,043). Elevation of orthochromic normoblasts did not influenced the overall survival of follicular lymphoma patients (p = 0,89). Conclusion. Bone marrow involvement in follicular lymphoma plays prognostically unfavourable role in long-time observation periods (later than 48 months). The most unfavourable are the intertrabecular patchy lesions. Involvement of bone marrow is in opposite relations to elevation of orthochromic normoblast, but the latter sign is of no prognostic significance.

Clinical and prognostic significance of bone marrow involvement in patients with diffuse aggressive B-cell lymphoma.

1995 ◽  
Vol 13 (6) ◽  
pp. 1336-1342 ◽  
Author(s):  
Y Yan ◽  
W C Chan ◽  
D D Weisenburger ◽  
J R Anderson ◽  
M A Bast ◽  
...  
Keyword(s):  
Bone Marrow ◽  
B Cell ◽  
Bone Marrow Involvement ◽  
International Prognostic Index ◽  
Prognostic Significance ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Term Survival

PURPOSE We studied the effect of morphology and extent of bone marrow (BM) infiltrate on the survival of patients with diffuse aggressive B-cell non-Hodgkin's lymphoma (NHL), along with clinical features. PATIENTS AND METHODS Sixty adult patients with diffuse aggressive B-cell NHL and BM involvement at the time of presentation were studied. All patients were uniformly staged and treated with a curative high-dose chemotherapy regimen. BM involvement was assessed according to the cytology, pattern of infiltration, and extent of involvement, and was correlated with overall survival (OS) and failure-free survival (FFS). RESULTS Patients with BM involvement that consisted of > or = 50% large cells or BM involvement of > or = 70% had a poorer OS (P = .065 and P = .055, respectively). Those who presented with an infiltrate of less than 50% large cells and an international prognostic index (IPI) of < or = 3 had a significantly longer postrelapse survival time (P = .003). A diffuse or interstitial pattern of BM involvement was predictive of both poor OS and FFS (P = .008 and .009, respectively). Multivariate analysis indicated that only IPI (P = .0005) and pattern of BM infiltration (P = .009) were independent predictors of OS, and only the former was predictive of FFS (P = .03). CONCLUSION The IPI is predictive of OS and FFS, while BM involvement with a diffuse or interstitial pattern is associated with significantly poorer OS. Patients with BM infiltration that involved > or = 70% of the marrow or contained > or = 50% large cells had poor OS, but more patients need to be studied to determine the significance. Two parameters, IPI < or = 3 and BM large cells less than 50%, identify a group of patients with long-term survival after relapse.

The prognostic significance of bone marrow involvement in diffuse large B cell lymphoma according to the flow cytometry

2019 ◽  
Vol 60 (10) ◽  
pp. 2477-2482 ◽  
Author(s):  
Uri Greenbaum ◽  
Itai Levi ◽  
Odelia Madmoni ◽  
Yotam Lior ◽  
Kayed Al-Athamen ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Flow Cytometry ◽  
B Cell ◽  
Cell Lymphoma ◽  
Bone Marrow Involvement ◽  
Prognostic Significance ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Bone Marrow Involvement in Anaplastic Large Cell Lymphoma:Immunohistochemical Detection of Minimal Disease and Its Prognostic Significance

1995 ◽  
Vol 103 (1) ◽  
pp. 82-89 ◽  
Author(s):  
Maximo Fraga ◽  
Pierre Brousset ◽  
Daniel Schlaifer ◽  
Catherine Payen ◽  
Alain Robert ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Involvement ◽  
Prognostic Significance ◽  
Large Cell ◽  
Minimal Disease

scholarly journals Comparison of three different methods to detect bone marrow involvement in patients with neuroblastoma

2021 ◽  
Author(s):  
Felix Schriegel ◽  
Sabine Taschner-Mandl ◽  
Marie Bernkopf ◽  
Uwe Grunwald ◽  
Nikolai Siebert ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Involvement ◽  
Prognostic Significance ◽  
Cost Effective ◽  
Study Entry ◽  
Diagnostic Tools ◽  
Number Of Patients ◽  
A Prospective Study ◽  
Positive Results

Abstract Purpose Neuroblastoma (NB) is the most frequent extracranial tumor in children. The detection of bone marrow (BM) involvement is crucial for correct staging and risk-adapted treatment. We compared three methods regarding the detection of NB involvement in BM. Methods Eighty-one patients with NB were included in this retrospective study. BM samples were obtained at designated time points at study entry and during treatment or follow-up. The diagnostic tools for BM analysis included cytomorphology (CM), flow cytometry (FCM) and automatic immunofluorescence plus fluorescence in situ hybridization (AIPF). Results We analyzed 369 aspirates in 81 patients in whom AIPF, CM, and FCM were simultaneously available. During the observation period, NB cells were detected in 86/369 (23.3%) cases, by CM in 32/369 (8.7%), by FCM in 52 (14.1%), and by AIPF in 72 (19.5%) samples. AIPF and/or FCM confirmed all positive results obtained in CM and detected 11 additional positive BM aspirates in 294 CM negative samples (p < 0,001). Survival of patients with BM involvement at study entry identified solely by FCM/AIPF was 17.4% versus 0% for patients in whom BM involvement was already identified by CM. Conclusion The combination of AIPF/FCM yielded the highest detection rate of NB cells in BM. AIPF was the single, most sensitive method in detecting these cells. Although CM did not provide any additional positive results, it is still a useful, readily available and cost-effective tool. The prognostic significance of FCM and AIPF should be confirmed in a prospective study with a larger number of patients.

Evaluation of Bone Marrow Trephine Biopsy: 134 Cases Over 8 Years -A Single Centre Experience

2018 ◽  
Vol 2 (02) ◽  
pp. 47-50
Author(s):  
Amin Lutful Kabir ◽  
Sayed Salahuddin Ahmed ◽  
Munim Ahmed ◽  
Md. Abdul Aziz ◽  
ASM Anwarul Kabir ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Hodgkin’S Lymphoma ◽  
Bone Marrow Involvement ◽  
Prognostic Significance ◽  
Hodgkin's Lymphoma ◽  
Trephine Biopsy ◽  
Diagnostic Dilemma ◽  
College Hospital ◽  
Bone Marrow Trephine ◽  
Haematological Disorders

Background: Trephine biopsy is a core biopsy of bone marrow using a special needle to evaluate the marrow architecture. Taking bone marrow biopsy alongside aspirate is still the most preferred practice for precise diagnosis and evaluation of various haematological and non- haematological disorders. Aims and objective: This study was carried out to evaluate the importance of this procedure in the diagnosis of various haematological and non-haematological disorders especially when bone marrow aspirates alone are non-diagnostic and to assess the prognostic significance of haematological malignancy. Materials and Methods: This was a retrospective study using the trephine biopsy and aspiration reports extracted from hospital records of Delta Medical College Hospital, Dhaka, over an 8years period from May 2009 to December 2016.The patient's profiles along with corresponding diagnoses and the necessary investigation reports were analysed. Result: Eighteen (26.47%) patients had bone marrow involvement for non-Hodgkin's lymphoma, three (4.41%) patients for Hodgkin's lymphoma, and acute lymphoblastic leukaemia was diagnosed in 18 (13.43%) patients, metastatic deposits in 6 (4.5%) patients, acute promyelocytic leukaemia in 3 (2.2%) cases, aplastic anaemia in 7 (5.2%) cases, chronic lymphocytic leukaemia in 1 (0.75%) case, multiple myeloma in 3 (2.2%) cases, myelofibrosis in 6 (4.5%) cases and chronic myeloid leukaemia and immune thrombocytopenic purpura were found in less than 1% cases. Total 37 patients (54.41 %) were reported as normocellular marrow with normal maturation among all the cases of lymphomas (N=68). One trephine biopsy was carried out to assess remission after induction chemotherapy in ALL. Conclusion: Trephine biopsy is an invaluable diagnostic tool in case of diagnostic dilemma and for follow up of patients undergoing chemotherapy and bone marrow transplantation. An expert haematopathological evaluation of the bone marrow trephine can impart light on actual diagnosis and have tremendous impact regarding patient management. 

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