Clinical, immunologic, and pathologic correlates of bone marrow involvement in 291 patients with acquired immunodeficiency syndrome–related lymphoma

Abstract

Bone marrow involvement is reported in approximately 25% of patients with newly diagnosed acquired immunodeficiency syndrome-related lymphoma (ARL). Studied were 291 patients with ARL, diagnosed and treated at one medical center between 1984 and 1998. Clinical, immunologic, and pathologic characteristics of patients with bone marrow involvement were compared with those of patients without marrow involvement. Bone marrow involvement was present in 55 patients (19%). Small noncleaved lymphoma was diagnosed in 38% of the entire group and was the most common pathologic subtype in patients with bone marrow involvement (55% versus 34%; P ‫؍‬ .008). Analysis of complete blood counts revealed a median hemoglobin level of 10.6 g/dL in both marrow-positive and marrownegative groups. In contrast, a platelet count lower than 100 000/L was more common in patients with bone marrow involvement (27% versus 11%; P ‫؍‬ .02). Patients with marrow involvement were more likely to have leptomeningeal (cerebrospinal fluid [CSF]) lymphoma than patients whose marrows were uninvolved (24% versus 7%; P < .001) and were also more likely to have high lactate dehydrogenase (LDH) (P ‫؍‬ .002), bone involvement (P < .001), and/or systemic B symptoms including fever, night sweats, and/or weight loss (P ‫؍‬ .05). Median survival did not differ between marrow-positive and marrow-negative groups. On multivariate analysis, factors associated with decreased survival of marrow-positive patients included greater than 50% involvement (P ‫؍‬ .002), systemic B symptoms (P ‫؍‬ .008), and high-grade histologic type (P ‫؍‬ .035). Marrow involvement in ARL correlates with small noncleaved pathology, thrombocytopenia lower than 100 000 mm 3 , high LDH, and lymphomatous involvement of the CSF. Survival is statistically shorter in patients with greater than 50% marrow involvement, high-grade pathology, and/or systemic B symptoms. (Blood. 2001;98:2358-2363)

Relation between some haematological abnormalities, degree of immunosuppression and viral load in treatment-naïve HIV-infected patients

“…The degree of thrombocytopenia was also directly related to the degree of immunosupression, in agreement with Jost et al [10] and the multicentre study [17]. A decrease in serum erythropoietin levels [16], auto-antibodies to erythropoietin or marrow suppression by opportunistic infections, tumours or various medications [16,[18][19][20] may also contribute to the anaemia commonly observed in HIV-infected persons.…”

Diagnostic yield of bone marrow examination in HIV associated FUO in ART naïve patients

“…In addition to the recommended investigations for diagnosis of FUO, bone marrow examination was done in each and every patient, and its diagnostic yield was calculated. Bone marrow examination is frequently undertaken, especially in the evaluation of unexplained or persistent fever [1], in suspected opportunistic infection with bone marrow involvement [5], or for staging in malignancy [6]. Findings of bone marrow examination in patients with AIDS have been described in the literature since the 1980s [7].…”

Should HIV-positive patients with lymphoma be offered stem cell transplants?

“…3 When these lymphomas occur in association with HIV infection, they tend to present with an advanced stage, B symptoms, extranodal sites of disease and commonly bone marrow involvement. [4][5][6] Prognostic factors associated with shortened survival for HIV-associated NHL include age 435 years, a history of intravenous drug abuse, stage III or IV disease, CD4 counts o100 and an elevated LDH. 7 In addition, the international prognostic index has been found to be highly correlated with survival.…”