Risk factors for poor treatment outcome and central nervous system relapse in diffuse large B-cell lymphoma with bone marrow involvement |
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Authors: | Keun-Wook Lee Jongyoun Yi In Sil Choi Jee Hyun Kim Soo-Mee Bang Dong-Wan Kim Seock-Ah Im Tae-You Kim Sung-Soo Yoon Jong Seok Lee Yung-Jue Bang Seonyang Park Byoung Kook Kim Han Ik Cho Dae Seog Heo |
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Institution: | 1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea 4. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea 6. Department of Laboratory Medicine, Seoul National University Hospital, Seoul, South Korea 8. Aerospace Medical Center, ROKAF, Cheongwon, Chungcheongbuk-do, South Korea 7. Department of Internal Medicine, Seoul Municipal Boramae Hospital, Seoul, South Korea 3. Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea 5. Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea 2. Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea 9. Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul, 110-744, South Korea
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Abstract: | Although several studies have described the prognostic implication of bone marrow (BM) involvement (BMI) in lymphoma, studies
focused on BM-involved diffuse large B-cell lymphoma (DLBCL) are very rare and small-sized. 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 BM-involved 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 failure-free survival (FFS) of 88 patients were
36.6 and 20.1 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 (5-year 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 levels.
K.-W. Lee and J. Yi equally contributed to this study. |
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Keywords: | Diffuse large B-cell lymphoma Bone marrow involvement Discordant histology Central nervous system Prognosis |
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