TY - JOUR
T1 - Occult bone marrow involvement in patients with diffuse large B-cell lymphoma
T2 - Results of a pilot study
AU - Talaulikar, Dipti
AU - Dahlstrom, Jane E.
AU - Shadbolt, Bruce
AU - McNiven, Michelle
AU - Broomfield, Amy
AU - Pidcock, Michael
PY - 2007/12
Y1 - 2007/12
N2 - Aims: It is known that advanced stage disease in diffuse large B-cell lymphoma (DLBCL) confers a poor prognosis, and staging investigations are routinely performed at diagnosis, including a bone marrow (BM) biopsy. However, examination of the BM is usually limited to routine light microscopy, with the role of ancillary investigations remaining unestablished. The aim of this pilot study was to estimate the incidence of occult marrow involvement using flow cytometry, immunohistochemistry and immunoglobulin heavy chain (IgH) gene rearrangements, and to determine the impact on survival. Methods: Clinical and pathological data were obtained on 36 patients diagnosed with DLBCL. Immunohistochemistry using CD3, CD45RO, CD20 and CD79a, and polymerase chain reaction (PCR) to look for IgH gene rearrangements were performed on formalin fixed BM trephines. Results: Nine patients had morphologically apparent BM involvement. Occult marrow involvement was found in seven of 36 (19.4%) patients using the additional diagnostic modalities. When these cases were included with morphologically apparent cases in a proposed new definition of marrow involvement, the median survival of patients with BM involvement was statistically worse (p = 0.02) than those without involvement. Conclusions: The results indicate that use of additional tests on BM at diagnosis can upstage disease for a proportion of patients, which appears to correlate adversely with survival.
AB - Aims: It is known that advanced stage disease in diffuse large B-cell lymphoma (DLBCL) confers a poor prognosis, and staging investigations are routinely performed at diagnosis, including a bone marrow (BM) biopsy. However, examination of the BM is usually limited to routine light microscopy, with the role of ancillary investigations remaining unestablished. The aim of this pilot study was to estimate the incidence of occult marrow involvement using flow cytometry, immunohistochemistry and immunoglobulin heavy chain (IgH) gene rearrangements, and to determine the impact on survival. Methods: Clinical and pathological data were obtained on 36 patients diagnosed with DLBCL. Immunohistochemistry using CD3, CD45RO, CD20 and CD79a, and polymerase chain reaction (PCR) to look for IgH gene rearrangements were performed on formalin fixed BM trephines. Results: Nine patients had morphologically apparent BM involvement. Occult marrow involvement was found in seven of 36 (19.4%) patients using the additional diagnostic modalities. When these cases were included with morphologically apparent cases in a proposed new definition of marrow involvement, the median survival of patients with BM involvement was statistically worse (p = 0.02) than those without involvement. Conclusions: The results indicate that use of additional tests on BM at diagnosis can upstage disease for a proportion of patients, which appears to correlate adversely with survival.
KW - Bone marrow
KW - Diffuse large B-cell lymphoma
KW - Flow cytometry
KW - Immunoglobulin heavy chain gene rearrangement
KW - Immunohistochemistry
KW - Staging
UR - http://www.scopus.com/inward/record.url?scp=36249025843&partnerID=8YFLogxK
U2 - 10.1080/00313020701684417
DO - 10.1080/00313020701684417
M3 - Article
SN - 0031-3025
VL - 39
SP - 580
EP - 585
JO - Pathology
JF - Pathology
IS - 6
ER -