Mediastinal Mass with Bone Marrow Involvement Is a Favorable Factor for Childhood T-Lymphoid Malignancy in Japan.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4525-4525
Author(s):  
Megumi Oda ◽  
Keiko Yumura-Yagi ◽  
Junichi Hara ◽  
Shinichiro Nishimura ◽  
Akio Tawa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Marrow ◽  
Prognostic Factors ◽  
T Cell ◽  
Mediastinal Mass ◽  
Bone Marrow Involvement ◽  
Stage Iv ◽  
Stage Iii ◽  
Lymphoid Malignancy ◽  
Specific Protocol

Abstract T-cell acute lymphoblastic leukemia (T-ALL) and T-cell lymphoblastic lymphoma (T-LBL) account for most of the childhood T-lymphoid malignancy(LM). T-ALL is usually treated by the same protocol to the B-progenitor ALL. It is obvious that biologically, T-cell behaviors are different from those of B-progenitor cell, and cell origins are same among T-ALL and T-LBL. Thus we conducted a strategy initiating T-ALL specific protocol, differing from protocols for B-progenitor ALL. Furthermore, we indicated the same protocol to advanced T-LBL. The aims of this study were to evaluate the efficacy and safety of indicating the same protocol for childhood T-ALL and advanced T-LBL, and to reveal the prognostic factors of childhood T-LM. 70 eligibleT-ALL patients enrolled in the JACLS ALL-97 study between 1997-2001, and 32 eligible patients with stage III and IV T-LBL enrolled in the JACLS NHL-T98 trial between 1998-2002 were analyzed. Median age was 9y8m (2y~15y3m) for T-ALL and 11y11m (3y~15y4m) for T-LBL. Male/female ratio was 46/24, 26/6, respectively. Mediastinal mass was found in 31/70(44.3%) for T-ALL, 19/21(90.5%) for stageIII and 6/11(54.5%) for stageIV T-LBL. The treatment for 2 years consisted of the induction therapy (VCR, HD-MTX, CA, PSL, ASP), the 5-drug consolidation therapy A and B, both including high dose of ASP, and maintenance therapy with block-rotated treatment using drugs above. Complete remission(CR) at the end of induction therapy was obtained 65/70(92.9%) for T-ALL, 15/21(71.4%) for stage III and 10/11(90.9%) for stage IV T-NHL. 5-year overall survival(OAS) rate for T-ALL, stage III and stage IV T-LBL was 81.1%, 63.9% and 81.8%, respectively. 5-year event free survival (EFS) rate was 72.9%, 47.6% and 72.3%, respectively. Relapse after CR occurred in 12/65 with T-ALL, 6/15 with stage III and 1/10 with stage IV T-LBL. Single variant analysis revealed that there were no significant difference in OAS or EFS for T-ALL patients based on WBC, NCI index, but statistical difference in OAS or EFS based on age(older than 10y worse), the existence of mediastinal mass(absence, worse) In T-LBL, there were no statistical differences based on age, existence of mediastinal mass. Multivariate analysis revealed, for T-ALL and T-LBL patients as a whole, that age > 10 years was a risk factor in both OAS and EFS, absence of mediastinal mass and stage III T-LBL were risk factors in OAS. Our data shows that indicating same T-cell specific protocol, for T-ALL and advanced T-LBL has a potential to improve the prognosis of T-LM. The older age, and stage III T-LBL appeared as prognostic factors. Moreover, mediastinal mass with bone marrow involvement was a favorable factor for childhood T-LM. Although some risk factors were documented, it is needed to clarify unknown prognostic factors and develop the more effective, stratified T-cell specific protocols.

The significance of bone marrow involvement in non-Hodgkin's lymphoma: the Eastern Cooperative Oncology Group experience.

1986 ◽  
Vol 4 (10) ◽  
pp. 1462-1469 ◽  
Author(s):  
J M Bennett ◽  
K C Cain ◽  
J H Glick ◽  
G J Johnson ◽  
E Ezdinli ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Hodgkin’S Lymphoma ◽  
Bone Marrow Involvement ◽  
Eastern Cooperative Oncology Group ◽  
Stage Iv ◽  
Hodgkin's Lymphoma ◽  
Stage Iii ◽  
Oncology Group ◽  
Non Hodgkin's Lymphoma

Data from four clinical trials conducted by the Eastern Cooperative Oncology Group (ECOG) were used to investigate the importance of bone marrow involvement as a prognostic factor in patients with non-Hodgkin's lymphoma (NHL). A total of 502 patients, 275 with nodular, poorly differentiated lymphocytic lymphoma (NLPD) and 227 with diffuse histiocytic lymphoma (DHL) or diffuse mixed-cell lymphoma (DML), were included in this analysis. Patients were separated into four categories: stage III, stage IV with bone marrow involvement (stage IV-M), stage IV without marrow involvement (stage IV-O), and stage IV with bone marrow and other organ involvement (stage IV-OM). Among the DHL and DML patients, the incidence of marrow involvement was 23%. However, stage IV-M patients had a prognosis that is similar to stage IV-O and stage IV-OM and worse than stage III patients. In contrast, the incidence of involvement with NLPD was 59% and patients with stage IV-M had a survival not different than stage III and not worse than stage IV-O and stage IV-OM. The results suggest that the current emphasis on bone marrow biopsy(s) as a routine diagnostic staging procedure for patients with NHL should be reevaluated. The necessity for this procedure in stage III patients with NLPD is not apparent from our data. One can still justify a bone marrow biopsy in stage I and II patients and can confirm the complete clinical response when all nodes have regressed in more advanced disease.

Detection of bone marrow involvement in breast cancer with magnetic resonance imaging.

1994 ◽  
Vol 12 (7) ◽  
pp. 1415-1421 ◽  
Author(s):  
S M Sanal ◽  
F W Flickinger ◽  
M J Caudell ◽  
R M Sherry
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Serum Alkaline Phosphatase ◽  
Bone Marrow Involvement ◽  
Stage Iv ◽  
Stage Ii ◽  
Stage Iii ◽  
Mri Findings ◽  
Two Stage ◽  
Bone Scans

PURPOSE To evaluate the value of magnetic resonance imaging (MRI) in detecting bone marrow metastases in patients with breast cancer. PATIENTS AND METHODS Twenty-three patients with breast cancer in various stages (stage IV, 11; stage III, five; stage II, seven) were evaluated for bone marrow involvement. MRIs of marrow from lumbar spine, pelvis, and proximal femora were obtained with a 1.5-Tesla unit. All patients underwent bilateral bone marrow aspirations and biopsies for histologic evaluation and immunostaining with monoclonal antibody (MoAB) against low-molecular weight cytokeratin (CAM 5.2). Marrow MRI findings were compared with technetium 99m bone scans. Patients with stage II or III disease were monitored for clinical outcome. Possible correlation of MRI findings with serum alkaline phosphatase level was explored. RESULTS Fourteen of 23 patients showed MRI abnormalities suggestive of metastatic marrow disease (stage IV, nine; stage III, two; stage II, three). In six patients with abnormal MRIs, histology and MoAB immunostaining confirmed marrow involvement (stage IV, five; stage III, zero; stage II, one). In the other eight patients with MRI abnormalities, neither of these methods confirmed the presence of marrow metastasis. Four of five operable breast cancer (stage II-III) patients with an abnormal initial MRI showed additional abnormalities on follow-up examination and developed metastatic disease within 5 to 18 months demonstrable by conventional clinical methods. Conversely, none of the operable patients with negative MRIs developed recurrent disease at 3 to 16 months (Student's t test, P = .01). Nine patients with a normal MRI had no evidence of marrow involvement with histologic or MoAB immunostaining (stage IV, two; stage III, two; stage II, five). Of 14 patients with abnormal MRIs, bone scans were normal in seven and failed to show corresponding abnormalities in six. Elevated serum alkaline phosphatase levels showed a direct relationship with abnormal bone scans indicating extensive bony involvement, but failed to correlate with positive marrow MRIs. CONCLUSION MRI is a promising new technique to detect occult marrow involvement in breast cancer patients. There is a good correlation between abnormal marrow MRI and early development of clinical metastatic disease in patients with stage II to III disease.

Pediatric T-Cell Lymphoblastic Leukemia and T-Cell Lymphoblastic Lymphoma: One and the Same or Two Different Diseases?.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1437-1437
Author(s):  
David Krieger ◽  
Anja Moericke ◽  
Wolfram Klapper ◽  
Franziska Greene ◽  
Martin Zimmermann ◽  
...  
Keyword(s):  
Bone Marrow ◽  
T Cell ◽  
Clinical Characteristics ◽  
Lymphoblastic Leukemia ◽  
Molecular Genetic ◽  
Bone Marrow Involvement ◽  
Stage Iv ◽  
P Value ◽  
Prognostic Impact ◽  
Chromosomal Deletions

Abstract Background/Objectives: Precursor T lymphoblastic neoplasms in children and adolescents are currently classified as either acute lymphoblastic T-cell leukemia (T-ALL) in case of ≥25% bone marrow involvement or lymphoblastic T-cell lymphoma (T-LBL) in case of <25% bone marrow involvement. This distinction is considered to be largely arbitrary because of overlapping biological and clinical features. However, comparative studies of smaller patient series reported differences of immunophenotypic and molecular genetic parameters, suggesting that T-ALL and T-LBL might indeed be biologically different. While deletions of certain chromosomal regions have long been identified in pediatric T-ALL, for T-LBL molecular or cytogenetic data are scarce. Design/Methods: The current study focused on the frequency, the association with clinical characteristics and the prognostic impact of selected chromosomal deletions, comparing 119 T-LBL patients (pts) with 125 T-ALL pts. T-LBL and T-ALL pts were registered in the NHL-BFM or ALL-BFM study center respectively. Both groups were treated according to ALL-BFM type treatment strategies. The molecular genetic analyses focused on chromosomal regions, harboring genes of functional relevance. Deletions were examined through loss-of-heterozygosity (LOH) analyses of 46 microsatellite markers. The following regions were analyzed: Chromosome 6q (25 markers), 7q (4 markers), 9p (5 markers), 11q (5 markers), 12p (6 markers) and p53 (1 marker). Samples of tumor and germline DNA were amplified by PCR, followed by fragment-length analysis with a genetic analyzer. Results: In 119 T-LBL pts a total of 4,780 markers and in 125 T-ALL pts a total of 5,730 markers were analyzed successfully. The frequency of LOH is depicted in table 1. Frequency of LOH in T-ALL and T-LBL patients T-LBL (n LOH + pts / n total pts) T-ALL (n LOH + pts / n total pts) p-value (Fisher) LOH at 6q 25 / 118 21% 15 / 125 12% 0.059 LOH at 7q 7 / 119 6% 2 / 124 2% 0.097 LOH at 9p 57 / 116 49% 63 / 125 50% 0.898 LOH at 11q 11 / 116 9% 3 / 125 2% 0.026 LOH at 12p 13 / 119 11% 9 / 125 7% 0.374 LOH at p53 4 / 76 5% 1 / 108 1% 0.161 Regarding clinical characteristics, LOH at 9p was associated with male gender in T-ALL and T-LBL. However, LOH at 9p was associated with elevated LDH level in T-ALL, but not in T-LBL. LOH at 12p was associated with female gender and mediastinal mass in T-ALL. In T-LBL, the 11 positive cases with LOH 12p showed an uncommon distribution of disease stages with more frequent stage II and stage IV disease. Regarding the prognostic impact, LOH at 6q was associated with an increased relapse rate in T-LBL but not in T-ALL. Interestingly, 2 of 3 T-ALL pts with LOH at 11q suffered from relapse compared to 0 out of 11 LOH 11q positive T-LBL pts. LOH at all other loci was not associated with a significant change in the risk of relapse. Conclusions: Chromosomal deletions found in pediatric T-ALL were also detected in pediatric T-LBL. However, the frequency, the association with clinical characteristics and the prognostic impact of these deletions differ between pediatric T-LBL and T-ALL. These results might be a new indicator that there are indeed differences between pediatric T-LBL and T-ALL.

Clinical Characteristics and Outcomes of 102 Patients with Adult T-Cell Leukemia/Lymphoma in Peru.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 5001-5001
Author(s):  
Brady Beltran ◽  
Domingo Morales ◽  
Pilar Quinones ◽  
Jorge Castillo
Keyword(s):  
Bone Marrow ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
T Cell ◽  
Performance Status ◽  
Bone Marrow Involvement ◽  
Type I ◽  
T Cell Leukemia ◽  
Cell Leukemia ◽  
Adult T Cell Leukemia

Abstract Abstract 5001 Background Adult T-cell leukemia/lymphoma (ATLL) is an aggressive disease associated with the human T-lymphotropic virus type-I (HTLV-I). ATLL has heterogeneous clinical presentations and outcomes. Shimoyama's ATLL classification includes acute, lymphomatous, chronic and smoldering subtypes. The objective of this study is to define prognostic factors for survival in patients with ATLL. Methods 102 ATLL cases were collected in our center between January 1997 and September 2008. A diagnosis of ATLL was made according to the following criteria: a clinical history consistent with ATLL, a positive HTLV-1 antibody by ELISA and Western Blot or evidence of HTLV-1 proviral integration by PCR, and histological findings compatible with ATLL. Descriptive statistics were used to assess categorical and continuous variables. Survival curves for OS were estimated using the Kaplan-Meier method and compared using the log-rank test. For the multivariate analysis, the Cox Proportional-hazard regression test was used. Results The median age at diagnosis was 60.5 years (range 23–92 years), with a female-to-male ratio of 1.2:1. Forty nine cases (48%) had a performance status ≥ 2. Clinical types were acute (n=45), lymphomatous (n=43), smoldering (n=3), cutaneous (n=10) and chronic (n=1). Median hemoglobin was 12.0 g/dl (range 5.2–17.4 g/dl), median albumin was 3.3 g/dl (range 1.8–4.6 g/dl), median beta-2 microglobulin was 4.4 g/dl (range 1.1–16.9 g/dl), and LDH was 808 UI/ml (range 298–13000 IU/ml). Twenty nine patients with acute ATLL were treated with chemotherapy obtaining an overall response rate (ORR) of 14% (4/29), 3 complete responses (CR) and 1 partial response (PR), while in 38 patients with lymphomatous ATLL, an ORR of 32% (12/38) was obtained, 8 CR and 4 PR. Smoldering and cutaneous ATL types received mainly topic treatments. Median overall survival (OS) was 2.4 months for the acute type, 11.4 months for the lymphomatous type, 17.2 months for the smoldering type and 39.4 months for the cutaneous type (p<0.00001 for trend). In the univariate analysis, presence of B symptoms (median OS 5.4 vs. 20.2 months; p=0.005), performance status ≥ 2 (median OS 3.5 vs. 15.6 months; p<0.005), clinical stage > 2 (median OS 5.7 vs. 39.4 months; p<0.005), high LDH levels (median OS 4.3 vs. 15.4 months; p<0.005), and bone marrow involvement (median OS 3.3 vs. 15.6 months; p<0.005) were associated with worse prognosis. In the multivariate analysis, bone marrow involvement and elevated LDH remained as adverse prognostic factors for survival. Conclusions ATLL is a heterogeneous disease with poor outcomes. Each ATLL subtype has distinct clinical features, including response rates and survival times. In this cohort of 102 cases, bone marrow involvement and elevated LDH levels were independent prognostic factors. Prospective studies are needed to further validate these observations. Disclosures No relevant conflicts of interest to declare.

The Role of Bone Marrow Examination in the Initial Evaluation of Pediatric Hodgkin’ Disease: The Canadian Perspective.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2326-2326
Author(s):  
David C. Simpson ◽  
Jun Gao ◽  
Conrad V. Fernandez ◽  
Margaret Yhap ◽  
Victoria E. Price ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Involvement ◽  
Stage Iv ◽  
Bone Marrow Examination ◽  
Pet Scan ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Significant Difference ◽  
The Impact

Abstract Hodgkin’s Disease (HD) is the most common lymphoma affecting young adults and teenagers. Bone marrow involvement is rare but if present, infers Stage IV disease and an inferior outcome. Adult studies have suggested that bone marrow examination (BME) may not be necessary unless certain risk factors are present. However, some pediatric centers continue to perform BME routinely on all children with HD. BME is invasive and generally performed under conscious sedation in children. We validated and administered an internet-based survey to examine the practice of all Canadian pediatric oncologists regarding BME in children with HD. We also retrospectively evaluated the impact of routine BME on the HD patients treated at our institution over the past 27 years. Forty-three percent of eligible physicians (n=93) completed the survey and 16 of a total of 17 Canadian pediatric oncology centers were represented. BME universally consisted of bilateral bone marrow aspirates and trephine biopsies. Routine BME for Stage III and IV disease was consistently practised nationally (by 92% and 97% of respondents, respectively). By contrast, 54% and 70% of respondents reported performing routine BME in low stage (Stage I and II) disease, respectively. Respondents were more likely to report performing routine BME in low stage patients, if their pediatric hematology/oncology training was entirely outside Canada (p=0.04 for Stage I and p=0.07 for Stage II) and if they practiced at smaller centers (p=0.05 for Stage I and p=0.03 for Stage II). There were no differences in practice regarding BME associated with the number of years in practice or the number of patients seen annually by the respondent. If not part of routine staging for all patients, BME was more likely performed if there were “B” symptoms, cytopenias, and/or bulky disease. Most respondents (95%) would proceed with BME following a positive PET scan. In the review of local institutional practice, 62 patients with HD and BME were eligible for analysis. Only 4 patients (6.5%) had a positive BME. No patient with otherwise low stage disease was found to have bone marrow involvement. Two patients, who would have been assigned as Stage III disease, were upstaged to Stage IV due to their BME. Comparison of staging with and without BME demonstrated no significant difference. Hemoglobin level was found to be the to be the only significant risk factor for marrow involvement based on univariate analysis(put in statisticp=0.006). Age, gender, histologic subtype, presence of “B” symptoms, and other blood parameters (white count, platelets, ESR and transaminases) were not significant factors. Practice regarding BME in children with low stage HD is highly variable across Canada. Bone marrow examination in pediatric patients with low stage HD should be abandoned, unless there is a specific indication to do so (for example positive PET scan or unexplained anemia). Moreover, BME does not appear to add any additional therapeutic direction for higher stage patients.

scholarly journals Utility of Bone Marrow Biopsy in the Staging of T-Cell Lymphoma in the PET-CT Era

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4039-4039
Author(s):  
Suchitra Sundaram ◽  
Matthew Gravina ◽  
Kristopher Attwood ◽  
Francisco J. Hernandez-Ilizaliturri ◽  
Pallawi Torka
Keyword(s):  
Bone Marrow ◽  
T Cell ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Bone Marrow Involvement ◽  
Stage Iv ◽  
Stage I ◽  
Newly Diagnosed ◽  
Pet Ct

Introduction: T-cell lymphomas (TCL) are a heterogenous group of lymphoid malignancies that account for 10-15% of all lymphoproliferative disorders. Histological bone marrow involvement (BMI) ranges between 20-40% of all TCLs at time of diagnosis with bone marrow aspirate and biopsy (BMAB) considered the gold standard test to detect BMI. 18-Fluoro-deoxyglucose positron emission tomography combined with computed tomography (PET-CT) is a standard pretreatment imaging in the staging of TCL. In other lymphomas like DLBCL, PET-CT may obviate the need for BMAB as a component for staging, but this has not been studied in TCL. The aim of this retrospective study is to determine the accuracy of PET-CT in detecting BMI in newly diagnosed TCL. Methods: This is a single institution retrospective medical chart review study. All TCL patients(pts) diagnosed at Roswell Park Cancer Institute between January 2003 to December 2017 and underwent pre-treatment PET-CT and BMAB were included. PET-CT images were visually assessed for BMI. We excluded cases in which BMAB specimens were qualitatively and/or quantitatively insufficient to determine the presence or absence of BMI. Ann Arbor staging was determined using PET-CT and BMAB and the proportion of patients upstaged to Stage IV due to BMI detected by either modality was calculated. The BMAB and PET-CT results were summarized using a 2x2 contingency table. The performance of the PET-CT was evaluated using the sensitivity, specificity, positive predictive value, and negative predictive value. Confidence intervals for these measures were obtained using Jeffrey's prior method. Results: In total 89 pts were included in the analysis. Median age at time of diagnosis was 60 (range 20-92), 52 were male (58%), 20 had elevated LDH (22%), 7 had ECOG greater or equal to 2 (8%), 66 had an IPI score 0-2 (74%) and 23 had an IPI score 3-4 (26%), 7 had >2 extra-nodal sites of involvement (8%). In total, 38 pts (42.6%) had BMI at time of diagnosis, established by either BMAB (n= 25; 28%), PET-CT (n=13; 15%) or by both modalities (n=10 pts; 11%). There were 15 pts (17%) that were negative for BMI on PET-CT but had positive involvement of TCL on BMAB. The sensitivity and specificity of PET-CT to detect BMI by TCL was 40% (95% CI 22.7, 59.4) and 95.3% (95% CI 88.0, 98.7), respectively. Seventy-one pts (79.7%) had concordant results between lymphomatous BMAB and PET-CT (10 pts were positive for both, 61 pts were negative for both) and 18 pts (20.2%) had discordant interpretation (15 pts were negative by PET-CT and positive by BMAB and 3 pts were negative by BMAB and positive on PET-CT). BMAB upstaged 4 out of the 32 (12.5%) stage I-II pts to stage IV; out of these only 1 patient had positive BMI detected by PET-CT. The positive predictive value of PET-CT for detecting BMI was found to be 76.9 % (50.3, 93.0) with a negative predictive value of 80.3 % (70.3, 88.0) (Figure 1). Conclusion:In our cohort of TCL pts, staging PET-CT does not identify all cases with BMI. BMAB upstaged more pts with Stage I/II to Stage IV than PET-CT. Although PET-CT has high negative predictive value for ruling out marrow involvement by TCL, BMAB remains a necessary component in the evaluation of pts with newly diagnosed TCL because of its ability to detect lymphomatous involvement of bone marrow missed by PET-CT which has implications in staging and treatment of TCL. Disclosures No relevant conflicts of interest to declare.

Follicular large-cell lymphoma treated with intensive chemotherapy: an analysis of 89 cases included in the LNH87 trial and comparison with the outcome of diffuse large B-cell lymphoma. Groupe d'Etude des Lymphomes de l'Adulte.

1997 ◽  
Vol 15 (4) ◽  
pp. 1654-1663 ◽  
Author(s):  
D Wendum ◽  
C Sebban ◽  
P Gaulard ◽  
B Coiffier ◽  
H Tilly ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Prognostic Factors ◽  
B Cell ◽  
Cell Lymphoma ◽  
Bone Marrow Involvement ◽  
B Cell Lymphoma ◽  
Large Cell ◽  
Intensive Chemotherapy ◽  
Large B Cell Lymphoma ◽  
Beta 2 Microglobulin

PURPOSE The aims of this study were as follows: (1) to analyze clinical, histopathologic characteristics, treatment outcome, and prognostic factors of patients with follicular large-cell lymphoma (FLCL); and (2) to compare them with those of patients with diffuse large B-cell lymphoma (DLCL) treated in the same therapeutic trial. PATIENTS AND METHODS Eighty-nine FLCL patients who were histologically reviewed and who received an intensive chemotherapy regimen according to the LNH 87 protocol were analyzed and compared with 1,096 B-cell DLCL patients included in the same protocol. RESULTS After intensive induction treatment, 59 patients (67%) achieved a complete remission [CR]. Estimated 5-year survival was 59%, and estimated 5-year freedom from progression (FFP) was 39%. Prognostic factors associated with shorter FFP were age greater than 60 years (P = .02), advanced clinical stage (P = .01), abnormal lactic dehydrogenase (LDH) level (P = .02), abnormal beta-2 microglobulin (P = .02), B symptoms (P = .03), bone marrow involvement (P = .04), and high expression of bcl-2 protein (P = .05). When compared with B-cell DLCL patients, FLCL patients were younger (P = .02), had a better Eastern Cooperative Oncology Group (ECOG) status (P = .05), less bulky mass (P = .04), more advanced clinical stages (P < .001), and more bone marrow involvement (P = .02). No significant difference was observed between FLCL and DLCL patients for response to therapy (67% v 67% of CR), 5-year overall survival (58% v 51%), 5-year disease-free survival (53% v 57%), or FFP survival (39% v 43%). CONCLUSION FLCL patients have a favorable response rate and survival when treated with intensive chemotherapy. Their outcome is similar to that of B-cell DLCL patients, and a long-term FFP is observed for a substantial number of patients. Some adverse prognostic factors (including those of the International Prognostic Index, bone marrow involvement, and beta-2 microglobulin) have been identified to define a subset of patients who require other therapeutic approach.

Bone marrow involvement by non-Hodgkin's lymphoma: the clinical significance of morphologic discordance between the lymph node and bone marrow. Nebraska Lymphoma Study Group.

1990 ◽  
Vol 8 (7) ◽  
pp. 1163-1172 ◽  
Author(s):  
M G Conlan ◽  
M Bast ◽  
J O Armitage ◽  
D D Weisenburger
Keyword(s):  
Bone Marrow ◽  
Lymph Node ◽  
T Cell ◽  
Cell Lymphoma ◽  
Bone Marrow Involvement ◽  
Large Cell ◽  
Small Cell ◽  
Low Grade ◽  
High Grade ◽  
Lymphoid Aggregates

Bone marrow specimens from 317 patients with non-Hodgkin's lymphoma (NHL) obtained at initial staging were evaluated for the presence of lymphoma or benign lymphoid aggregates. Thirty-two percent (102 patients) had lymphoma in their bone marrow, and 9% had benign lymphoid aggregates. Bone marrow lymphoma was present in 39% of low-grade, 36% of intermediate-grade, and 18% of high-grade lymphomas. The bone marrow was involved in 25% of patients with diffuse large-cell or immunoblastic NHL (ie, diffuse histiocytic lymphoma of Rappaport). Bone marrow involvement did not affect survival of patients with low-grade NHL, but survival was significantly shorter (P = .03) for patients with intermediate- and high-grade NHL with bone marrow involvement. Bone marrow involvement was equally common in B-cell and T-cell NHL (31% v 32%). However, patients with T-cell NHL and bone marrow involvement had shorter survival than B-cell NHL with marrow involvement (P = .02) or T-cell NHL without marrow involvement (P = .05). A high incidence of morphologic discordance between lymph node and bone marrow was observed (ie, 40%), always with a more aggressive subtype in the lymph node than in the bone marrow. Presence of large-cell lymphoma in the bone marrow predicted for short survival. Survival for patients with small-cell lymphoma in their bone marrow did not differ significantly from patients with negative bone marrows. We conclude that bone marrow involvement in large-cell NHL, especially in those of T-cell origin, portends a poor prognosis. However, the subgroup of patients with an aggressive histologic subtype of NHL in a lymph node biopsy and small-cell NHL in the bone marrow do not have a poorer outlook than those without bone marrow involvement.

Prognostic factors in aggressive malignant lymphomas: description and validation of a prognostic index that could identify patients requiring a more intensive therapy. The Groupe d'Etudes des Lymphomes Agressifs.

1991 ◽  
Vol 9 (2) ◽  
pp. 211-219 ◽  
Author(s):  
B Coiffier ◽  
C Gisselbrecht ◽  
J M Vose ◽  
H Tilly ◽  
R Herbrecht ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Serum Albumin ◽  
Serum Albumin Level ◽  
Bone Marrow Involvement ◽  
Prognostic Index ◽  
Albumin Level ◽  
Advanced Stage ◽  
Low Serum

The objectives of this study were to determine prognostic factors for response to treatment, freedom-from-relapse (FFR) survival, and overall survival of 737 aggressive malignant lymphoma patients treated with the doxorubicin, cyclophosphamide, vindesine, bleomycin, methylprednisolone, methotrexate with leucovorin, ifosfamide, etoposide, asparaginase, and cytarabine (LNH-84) regimen; to construct a prognostic index with factors isolated by multivariate analyses; and to validate this prognostic index with another set of patients. Complete response (CR) was reached in 75% of LNH-84 patients, and 30% of them relapsed. With a median follow-up of 36 months, median FFR survival and median overall survival were not reached. Low serum albumin level, high tumoral mass, weight loss, bone marrow involvement, greater than or equal to 2 extranodal sites, and increased lactic dehydrogenase (LDH) level were associated with a low response rate. Advanced stage, increased LDH level, and nonlarge-cell histologic subtypes (diffuse mixed, lymphoblastic, and small non-cleaved) were statistically associated with a high relapse rate and short FFR survival. Increased LDH level, low serum albumin level, tumoral mass larger than 10 cm, greater than or equal to 2 extranodal sites, advanced stage, and age older than 65 years were statistically associated with short overall survival. Four of these parameters, namely, LDH level, stage, number of extranodal sites, and tumoral mass, were put together to construct a prognostic index. This index partitioned LNH-84 patients into three subgroups of good, intermediate, and poor prognosis (P less than .00001): CR rates of 93%, 83%, and 61%; relapse rates of 12%, 25%, and 45%; 3-year FFR survival of 87%, 73%, and 53%, and 3-year survival of 88%, 71%, and 41%, respectively. This prognostic index was applied to a test set of patients: 155 patients treated on protocols of the Nebraska Lymphoma Study Group. Using this index, these patients had 3-year FFR survival of 70%, 40%, and 22% (P = .0002) and 3-year survival of 79%, 52%, and 31% (P = .005). In patients with aggressive lymphomas, this simple prognostic index could distinguish between patients requiring intensive treatment such as autologous bone marrow transplantation in first complete remission and those who could be treated with standard regimens.

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