Diagnostic bone marrow biopsy in patients with stage I EMZL treated with radiation therapy: needed or not?

Alderuccio, Juan Pablo; Isrow, Derek; Reis, Isildinha M.; Iyer, Sunil; Meshman, Jessica; Zhao, Wei; Vega, Francisco; Chapman, Jennifer R.; Markoe, Arnold M.

doi:10.1182/blood.2019003236

Cited by 8 publications

(7 citation statements)

References 22 publications

(30 reference statements)

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“…PET/CT for detection of BM disease has recently been evaluated in several studies in both HL and NHL 32–34,46–48 . The 2014 Lugano classification proposes omitting routine BM biopsy in patients with HL based on data from the Danish Lymphoma Registry study 30 .…”

Section: Discussionmentioning

confidence: 99%

“…44,45 PET/CT for detection of BM disease has recently been evaluated in several studies in both HL and NHL. [32][33][34][46][47][48] The 2014 Lugano classification proposes omitting routine BM biopsy in patients with HL based on data from the Danish Lymphoma Registry study. 30 biopsy remains endorsed by European Society for Medical Oncology and National Comprehensive Cancer Network guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…PET/CT for detection of BM disease has recently been evaluated in several studies in both HL and NHL. 32 , 33 , 34 , 46 , 47 , 48 The 2014 Lugano classification proposes omitting routine BM biopsy in patients with HL based on data from the Danish Lymphoma Registry study. 30 However, insufficient data are available for the sensitivity and specificity of PET/CT for detection of BM involvement in ENKTCL; therefore, routine BM biopsy remains endorsed by European Society for Medical Oncology and National Comprehensive Cancer Network guidelines.…”

Section: Discussionmentioning

confidence: 99%

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The value of routine bone marrow examination in patients with extranodal NK/T‐cell lymphoma staged with PET/CT

Yang

Ji-Jin

Zhao

et al. 2022

Cancer

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Background: Limited evidence supports the omission of routine bone marrow (BM) examination (biopsy and aspiration) in patients with nasal-type extranodal NK/T-cell lymphoma (ENKTCL). This study was aimed at assessing whether BM examination provides valuable information for positron emission tomography/computed tomography (PET/CT)-based staging in this patient population. Patients and Methods: Patients newly diagnosed with ENKTCL who underwent initial staging with both PET/CT and BM examination between 2013 and 2020 were retrospectively identified in two Chinese institutions. Overall, 742 patients were included; the BM examination was positive in 67 patients. Results: Compared with BM biopsy alone, the combination of BM biopsy and aspiration assessment did not afford any additional diagnostic value. No patient with a positive BM biopsy was found to have early-stage disease by PET/CT.BM biopsy or PET/CT led to upstaging from stage III to IV as a result of BM involvement in 21 patients. In 135 patients with distant organ involvement, BM involvement was associated with worse overall survival (OS) and progressionfree survival (PFS) compared with the corresponding durations in patients without BM involvement (2-year OS: 35.9% vs. 60.4%, p < .001; PFS: 26% vs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The value of routine bone marrow examination in patients with extranodal NK/T‐cell lymphoma staged with PET/CT

Yang

Ji-Jin

Zhao

et al. 2022

Cancer

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“…LDH elevation is uncommon in patients with localized ocular adnexa EMZL in general, and specifically in conjunctival EMZL 19 ; therefore, patients with missing LDH values were grouped with the "low-risk category" in calculation of MALT-IPI score. BM involvement is also uncommon in these patients (<10%) 19 and since we have previously demonstrated that BM examination lacks survival impact in patients with stage I EMZL determined by physical examination/ imaging studies and treated with frontline RT, 22 disease, according to the current Ann Arbor staging classification. 23 All patients were further categorized according to the TNM-AJCC International Union Against Cancer ocular lymphoma staging system.…”

Section: Patientsmentioning

confidence: 98%

Long‐term outcomes of patients with conjunctival extranodal marginal zone lymphoma

et al. 2022

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Comprehensive information on clinical features and long‐term outcomes of primary conjunctival extranodal marginal zone lymphoma (PCEMZL) is scarce. We present a large single‐institution retrospective study of 72 patients. The median age was 64 years, and 63.9% were female. Stage I was present in 87.5%. Radiation therapy (RT) alone was the most common treatment (70.8%). Complete response (CR) was 87.5%, and 100% in RT‐treated patients. With a median follow‐up of 6.7 years, relapse/progression and death occurred in 19.4% each, with one relapse within the RT field. The 10‐year progression‐free survival (PFS) and overall survival (OS) were 68.4% (95% CI 52.8%–79.8%) and 89.4% (95% CI 77.4%–95.2%), respectively. The 10‐year rate for time to progression from diagnosis was 22.5% (95% CI 11.6%–35.7%). The 10‐year PFS and OS of MALT‐IPI 0 versus 1–2 were 83.3% versus 51.3%, (p = .022) and 97.6% versus 76.6%, (p = .0052), respectively. The following characteristics were associated with shorter survival: age > 60 years (PFS: HR = 2.93, 95% CI 1.08–7.95; p = .035, OS: HR = 9.07, 95% CI 1.17–70.26; p = .035) and MALT‐IPI 1–2 (PFS: HR = 2.67, 95% CI 1.12–6.31; p = .027, OS: HR = 6.64, 95% CI 1.45–30.37; p = .015). CR following frontline therapy was associated with longer PFS (HR = 0.13, 95% CI 0.04–0.45; p = .001), but not OS. Using the Fine and Gray regression model with death without relapse/progression as a competing risk, RT and CR after frontline therapy were associated with lower risk of relapse (SHR = 0.34, 95% CI 0.12–0.96 p = .041 and SHR = 0.11, 95% CI 0.03–0.36; p < .001, respectively). Patients with PCEMZL treated with frontline RT exhibit excellent long‐term survival, and the MALT‐IPI score appropriately identifies patients at risk for treatment failure.

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“…Staging work-up has been well standardized across lymphoma subtypes; however, it remains ambiguous in MZL. [14][15][16][17][18] Current frontline regimens were derived from phase III clinical trials largely based on FL patients, that frequently included relatively small cohorts of MZL patients spanning all subtypes as a single group.…”

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confidence: 99%

A roadmap for clinical trial design in marginal zone lymphoma

et al. 2022

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Diagnostic bone marrow biopsy in patients with stage I EMZL treated with radiation therapy: needed or not?

Cited by 8 publications

References 22 publications

The value of routine bone marrow examination in patients with extranodal NK/T‐cell lymphoma staged with PET/CT

The value of routine bone marrow examination in patients with extranodal NK/T‐cell lymphoma staged with PET/CT

Long‐term outcomes of patients with conjunctival extranodal marginal zone lymphoma

A roadmap for clinical trial design in marginal zone lymphoma

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