B-chronic lymphocytic leukemia. Prognostic implication of bone marrow histology in 120 patients experience from a single hematology unit

Abstract

The available staging systems for B-chronic lymphocytic leukemia (B-CLL) do not always predict the clinical course and the prognosis of the disease. In these systems, the pattern of bone marrow histology is not incorporated. In the current report we investigate the prognostic value of the diffuse or nondiffuse pattern of bone marrow involvement in 120 B-CLL patients in relation to their actuarial survival, and we compare these results with the actuarial survival based on the International Workshop system. In addition, we analyze the influence of the diffuse or nondiffuse pattern on the actuarial survival, in relation to the individual clinical stages (A, B, C). All patients were diagnosed and followed-up in the same Unit. Our patients were divided into Stage A (64), Stage B (22), and Stage C (34). They were also subdivided into those with a diffuse (46) and those with a nondiffuse (74) pattern of bone marrow histology. The difference in the actuarial survival in relation to their clinical stage (A, B, C) was statistically significant (P < 0.025). A greater statistical difference (P < 0.005) was found when the actuarial survival was analyzed in relation to the diffuse or nondiffuse pattern of bone marrow histology. No statistically significant differences could be found (P > O.l), when the actuarial survival was calculated in every stage (A, B, C), on the basis of the diffuse or nondiffuse pattern of bone marrow histology. When our Stage A and B patients were analyzed for disease progression, in relation to the diffuse or nondiffuse bone marrow histology, it was found that 66.6% of the diffuse Stage A patients and 88% of the diffuse Stage B patients had disease progression as compared to only 8.6% for the nondiffuse Stage A patients and 33% for the nondiffuse Stage B patients. Our findings indicate that: the pattern of bone marrow histology in B-CLL patients is the single most important prognostic parameter in this disease; a clinicopathologic staging system for B-CLL may be justified; and the diffuse pattern of bone marrow histology could be considered as the best criterion for initiation of therapy in these patients. Cancer 59:767-771. 1987. HE M I clinical staging system' has offered significant T help in the management and protocol studies of chronic lymphocytic leukemia (CLL). More recently, an

Structure and function of the hematopoietic cancer niche focus on chronic lymphocytic leukemia

“…A diffuse infiltration refers to a uniform replacement of normal hematopoietic tissues by CLL cells, while in nodular and interstitial infiltrations, there is gross preservation of areas of normal marrow architecture (5). The extent of marrow infiltration by CLL cells correlates with the severity of the prognosis, where extensive marrow replacement is generally associated with advanced clinical stage and/or aggressive disease (5,7). The lymph nodes and spleen of CLL patients typically are diffusely infiltrated with monomorphic, small, round lymphocytes that efface the normal lymphoid-tissue architecture (8,9).…”

“…The marrow of CLL patients is invariably infiltrated with CLL cells, following a pattern that can be diffuse and extensive, interstitial, nodular, or a mixture of interstitial and nodular (4)(5)(6). A diffuse infiltration refers to a uniform replacement of normal hematopoietic tissues by CLL cells, while in nodular and interstitial infiltrations, there is gross preservation of areas of normal marrow architecture (5). The extent of marrow infiltration by CLL cells correlates with the severity of the prognosis, where extensive marrow replacement is generally associated with advanced clinical stage and/or aggressive disease (5,7).…”

Bone marrow trephine biopsy in lymphoproliferative disease.

“…Bone marrow biopsy is mandatory for staging lymphomas and useful in monitoring treatment. 3 Valuable information on the state of haematopoiesis and changes in stromal components is also provided by trephine biopsy specimens.4 Bone marrow biopsy specimens are especially important in the staging of Hodgkin's disease, because pathology in the marrow indicates systemic disease and an unfavourable prognosis,5 6 and they are of confirmed value in histological staging and grading of multiple myeloma where histology has been shown to be more accurate than aspiration cytology for quantifying tumour cell burden.7…”

Structure and function of the hematopoietic cancer niche: focus on chronic lymphocytic leukemia

“…The marrow of CLL patients is invariably infiltrated with CLL cells, following a pattern that can be diffuse and extensive, interstitial, nodular, or a mixture of interstitial and nodular (4–6). A diffuse infiltration refers to a uniform replacement of normal hematopoietic tissues by CLL cells, while in nodular and interstitial infiltrations, there is gross preservation of areas of normal marrow architecture (5). The extent of marrow infiltration by CLL cells correlates with the severity of the prognosis, where extensive marrow replacement is generally associated with advanced clinical stage and/or aggressive disease (5, 7).…”