Authors: KeunWook Lee Jongyoun Yi In Sil Choi Jee Hyun Kim SooMee Bang DongWan Kim SeockAh Im TaeYou Kim SungSoo Yoon Jong Seok Lee YungJue Bang Seonyang Park Byoung Kook Kim Han Ik Cho Dae Seog Heo
Publish Date: 2009/01/27
Volume: 88, Issue: 9, Pages: 829-838
Abstract
Although several studies have described the prognostic implication of bone marrow BM involvement BMI in lymphoma studies focused on BMinvolved diffuse large Bcell lymphoma DLBCL are very rare and smallsized This study was performed to examine the prognostic impact of morphologic findings of BMI by lymphoma and risk factors for central nervous system CNS relapse in BMinvolved DLBCL Between 1993 and 2005 675 patients were diagnosed with DLBCL and 88 patients who had BMI at initial diagnosis were eligible for this study The median overall survival OS and failurefree survival FFS of 88 patients were 366 and 201 months respectively When three variables from BM morphologic findings the pattern of BM infiltration extent of BMI by lymphoma and percentage of large cells in the infiltrate were simultaneously included into multivariate model the increased extent of BMI by lymphoma ≥10 in BM area was the only negative prognostic factor independent of the International Prognostic Index IPI Patients with both lower IPI scores and less extent of BMI showed an excellent prognosis with chemotherapy alone 5year OS and FFS rates 80 and 69 However morphologic BM features were not independent predictive factors for CNS recurrences An increased lactate dehydrogenase LDH level at initial diagnosis was the only independent predictive factor for CNS relapse Further efforts should be directed toward finding optimal treatment modalities based on the IPI and the extent of BMI by lymphoma CNS prophylaxis may be considered only in patients with initial elevated LDH levelsWe are grateful to SeoKyung Hahn of Medical Research Collaborating Center Seoul National University Hospital for her statistical assistance in the revision of this manuscript This study was partially supported by a grant from the Innovative Research Institute for Cell Therapy Republic of Korea A062260
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