Can flow cytometry of bone marrow aspirate predict outcome of patients with diffuse large B cell lymphoma? A retrospective single centre study

Abstract

Bone marrow (BM) trephine biopsy is a part of routine staging of patients with newly diagnosed diffuse large B cell lymphoma (DLBCL). The significance of lymphoid monoclonal population on flow cytometry (FC) of the BM aspirate in the presence of negative BM histology has not been clarified. In this study, we assessed the clinical role of positive FC in predicting outcome of patients with DLBCL and a negative BM histology. We retrospectively analysed 101 patients diagnosed with DLBCL at a single institution between years 1994-2003. Three groups of patients were compared: patients with histologic involvement of the BM (BM+), patients with no histologic involvement of the BM but with positive FC (BM-FC+) and patients with neither histologic or FC evidence of BM involvement (BM-FC-). The BM+ group included 13 patients (13%). The BM-FC+ group 16 patients (16%), and the BM-FC-included 72 patients (71%). Median age of the cohort was 67 years. Disease stage and International Prognostic Index score were significantly higher in the BM+ and BM-FC+ groups compared with the BM-FC- group. Median overall survival (OS) for the BM-FC-, BM-FC+ and BM + groups were 4.6, 2.2 and 0.9 years, respectively. Median progression free survival (PFS) for the BM-FC-, BM-FC+ and BM+ groups were 3.2, 1.4 and 0.6 years, respectively (p=0.01 for both analysis). In multivariable Cox regression models adjusting for age, sex, stage and International Prognostic Index, there was no significant differences in OS or PFS between the BM-FC+ and BM-FC- groups. In conclusion, positive FC in the setting of negative BM histology at diagnosis did not significantly affect OS or PFS.

Combination of Bone Marrow Biopsy and Flow Cytometric Analysis: The Prognostically Relevant Central Approach for Detecting Bone Marrow Invasion in Diffuse Large B-Cell Lymphoma

“…Based on this finding, we speculate the complementary role between the two modalities. Although the prognostic association between BM involvement detection by biopsy and FCM has been controversial [ 18 , 19 , 20 , 27 ], our result indicated the combination of BM biopsy and FCM as the central component in BM analysis. BM smear and clot examinations are also useful modalities, as they may provide additional information and play the alternative role in some clinical situations.…”

“…Antigens examined included CD2, CD3, CD4, CD7, CD8, CD10, CD11c, CD16, CD19, CD20, CD23, CD25, CD34, CD45, CD56, kappa light chain, and lambda light chain. The presence of light chain restriction in B lymphoid cells was regarded as positive BM invasion [ 15 , 16 , 17 , 18 , 19 , 20 ]. BM aspirate smear specimen was subjected to Wright–Giemsa staining and 500 BM nucleated cells were cytologically evaluated to detect abnormal lymphoid cells under an optical microscope.…”

Comparative Review of the Current and Future Strategies to Evaluate Bone Marrow Infiltration at Diffuse Large B-Cell Lymphoma Diagnosis

“…Two studies [43,49] that analyzed outcomes after combining BMB/FCM findings described discrepancies about the worse prognosis of BMB+/FCM+ cases compared with BMB−/FCM+ ones. On the one hand, M. Moro et al reported that the BMB−/FCM+ group presented an adverse outcome equivalent to the BMB+/FCM+ population; similar findings were described in another study not included in the comparative review due to insufficient data [56]. On the other hand, Greenbaum et al described that the prognosis of BMB−/FCM+ cases was intermediate between the BMB−/FCM− and the BMB+/FCM+ groups.…”

A Comparison of Bone Marrow Flow Cytometry Findings and Bone Marrow Biopsy İmmunohistochemical Findings in Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma: A Methodological Study

“…The World Health Organization (WHO) classification of mature B-cell leukaemia/lymphoma, as in other hematological malignancies, morphology, immunophenotypic characteristics, genetic and clinical findings are used (1). Immunophenotypic classification plays an important role in determining the cell origin of mature B-cell leukemia/lymphoma, as well as in patient management and follow-up, and is a sensitive method (2). Immunophenotyping is performed by immunohistochemical (IHC) studies in bone marrow biopsies and with by flow cytometry (FC) in bone marrow aspirate suspensions (1).…”