Impact of Concordant and Discordant Bone Marrow Involvement on Outcome in Diffuse Large B-Cell Lymphoma Treated With R-CHOP

Sehn, Laurie H.; Scott, David W.; Chhanabhai, Mukesh; Berry, Brian; Ruskova, Anna; Berkahn, Leanne; Connors, Joseph M.; Gascoyne, Randy D.

doi:10.1200/jco.2010.33.3419

Cited by 209 publications

(220 citation statements)

References 22 publications

Supporting

Mentioning

150

Contrasting

Unclassified

Order By: Relevance

“…18 F]-FDG PET was not predictive of BM pathology [12,13,16,[19][20][21][22][23][24]. This is also our point of view and we believe that it should be �� MIP and axial images from a 35 year old male shows focal FDG uptake at the lower thoracic spine.…”

Section: Discussionmentioning

confidence: 90%

“…Discordant findings were associated to worse outcomes only if the BM biopsy (BM b ) was positive [13]. The utility of FDG PET-CT in evaluating BM involvement has also been explored by other authors with variable results as to its benefit [6,7,[12][13][14][15][16][17][18][19][20][21][22][23]. Because FDG PET-CT's are performed routinely now in the pretherapy staging of most lymphoma patients, extracting noninvasively additional information in regards to bone marrow status would be very valuable.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pre-Treatment FDG PET Bone Marrow (BM) Uptake and Disease Involvement. Can Semiquantitative Measures Discriminate Between A Normal, Hypercellular or Infiltrated Bone Marrow?

Ahmed¹,

Yao²,

Fourzali

et al. 2013

J Bone Marrow Res

View full text Add to dashboard Cite

PET studies are used on a regular basis to stage lymphoma patients pretreatment. Bone marrow uptake (BM u ) can be associated with disease involvement, however occasionally uptake is related to benign etiologies (anemia, stimulation, a hypercellular marrow etc…). Uncovering quantitative and qualitative parameters to elucidate the etiology of (BM u ) may help the radiologist and oncologist in cases where a BM biopsy (BM b ) cannot be performed or interpreted by the pathologist or is unavailable. We looked retrospectively at a group of consecutive lymphoma patients (pts) who had an initial staging PET scan. Out of 121 patients, 36 had a (BM b ) report available for review. We attempted to evaluate whether semi quantitative parameters -maximum standardized uptake value (SUVm); Average SUV (SUVav); SUVm/Mediastinal blood pool (MBP) ratio -could discriminate between different bone marrow patterns (normal, hypercellular, positive). We also looked at the type of BM u (none; mild; prominent) and pattern (patchy; diffuse; focal). The average age of our patient population was 52.19. 66.66% were males (24/36). Most of our patient's had a normal BM b . 25 % (9/36) had a positive BM. In the BM positive group, no pts had patchy uptake and 2 pts were found to have no appreciable uptake. In the BM normal group 71.5 % (15/21) had either mild or prominent uptake and only 28.5% had no uptake. None had focal uptake and 90% of pts had diffuse uptake. The majority of whole cohort had a SUVm> 2.5: 90 % of BM normal; 100% of hypercellular BM and 88.88% of the BM positive group and an SUVm/MBP>2.5: 52.4%; 66.66% and 55.5% respectively. Using a Chi-square test BM Pathology level was overall significantly different across the BM u patterns (p=0.0192). Analysis looking at BM positive versus BM negative groups, shows BM pattern is no longer a significant variable to predict BM pathology (p=0.168). Subsequently, the odds ratio of having only positive BM pathology based on focal vs. patchy pattern is not significant. Conclusion:No qualitative or semi quantitative parameters were found to be statistically significantly associated with BM pathology. Further exploration in a larger cohort is necessary.

show abstract

Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Pre-Treatment FDG PET Bone Marrow (BM) Uptake and Disease Involvement. Can Semiquantitative Measures Discriminate Between A Normal, Hypercellular or Infiltrated Bone Marrow?

Ahmed¹,

Yao²,

Fourzali

et al. 2013

J Bone Marrow Res

View full text Add to dashboard Cite

show abstract

“…39 When coincident DLBCL is present both at the primary site and in the bone marrow, 5-10% of patients have or later develop CNS involvement. Such patients should be considered for prophylactic CNS treatment with high-dose methotrexate or intrathecal chemotherapy although at present firm evidence that such an intervention reduces risk of CNS relapse is lacking.…”

Section: Bone Marrow ± Peripheral Blood Involvement With B-cell Lymphomamentioning

confidence: 99%

Non-Hodgkin lymphoma: the clinician's perspective—a view from the receiving end

Connors

2013

Modern Pathology

View full text Add to dashboard Cite

Optimal treatment of non-Hodgkin lymphoma depends on establishing an accurate diagnosis and determining the stage or anatomic extent of the lymphoma. With this information, the treating clinician can assign the lymphoma to a subgroup characterized by expected natural history: indolent, aggressive, acute leukemia-like or viral, which generally reflects the typical behavior of the disease unmodified by treatment and indicates the urgency with which intervention must be offered. Finally, a number of special circumstances and problems posed by specific lymphomas must be anticipated and the therapeutic plan altered to accommodate them. After primary treatment, special secondary events such as transformation to more aggressive histologic types must be recognized and the treatment plan must be altered to address these events. This article reviews standard diagnostic grouping of lymphomas, special problems encountered during primary diagnosis and subsequent clinical evolution and emphasizes the cooperative interaction between the hematopathologist and the treating clinician that underlies optimal management.

show abstract

“…4,7,8 This "concordant" BM involvement is independently associated with poor PFS and OS 4,7,8 and a higher rate of primary refractory disease.…”

mentioning

confidence: 97%

“…Indeed, a minority of DLBCL patients present with indolent histology at the time of disease relapse. 4 Finally, it is important to note that EFS curves diverged after 1.5 years but reached the maximal difference after four years, due to the development of late events (which might have been represented by relapse) between four and seven years, which are rather infrequent in DLBCL.…”

mentioning

confidence: 98%

Comment on "Rituximab maintenance for patients with aggressive B-cell lymphoma in first remission: results of the randomized NHL13 trial"

2015

View full text Add to dashboard Cite

We read with interest the recent report of the NHL13 randomized trial, which evaluated a 2-year rituximab maintenance program versus no further treatment in patients with diffuse large B-cell lymphoma (DLBCL; n=662) or follicular lymphoma grade 3b (n=21), who had achieved a complete remission (CR) or CR unconfirmed (CRu) with 4-8 cycles of CHOP or similar chemotherapy and 8 rituximab applications.1 Overall, NHL13 was a "negative" trial: the 3-year event-free survival (EFS) was 80.4% in the rituximab maintenance arm versus 76.5% in the observation arm (P=0.14), while 3-year overall survival (OS) remained unchanged (92.0% vs. 90.4%). However, subgroup analysis revealed very interesting findings. Although rituximab maintenance did not work in females at all and toxicity was higher, males enjoyed a statistically and numerically significant benefit with a 3-year EFS of 84.1% versus 74.4% for rituximab maintenance versus observation (P=0.03), and a 3-year progression-free survival (PFS) of 89.0% versus 77.6% (P=0.006), but again with no impact on OS. Indeed, rituximab maintenance might have overcome the reduced exposure of elderly males to rituximab due to its faster clearance,2 similarly to what was observed in the SEXIE-R trial, where higher rituximab doses in induction obscured the adverse significance of male sex.3 A closer look at Figure 3 1 also reveals that a potential benefit from rituximab maintenance was more prominent in good risk patients according to most International Prognostic Index (IPI) factors (stage I/II, performance status 0-1, low LDH, <2 extranodal sites). As a result, low IPI risk males had the best outcomes. A notable exception to this "rule" was the observation that the 74 patients with bone marrow (BM) involvement (approx. 10% of the total number of patients), a feature associated with adverse prognosis, gained the most significant benefit from rituximab maintenance compared to any other patient subgroup (hazard ratio 0.31, 95%CI: 0.13-0.71, P=0.006 vs. a hazard ratio of 0.90, 95%CI: 0.64-1.26, P=0.53 for patients without BM involvement).Bone marrow involvement is observed in 13%-20% of patients with DLBCL.4-8 Bone marrow can be infiltrated by large cells in slightly more than 50% of these cases. 4,7,8 This "concordant" BM involvement is independently associated with poor PFS and OS 4,7,8 and a higher rate of primary refractory disease.7 In the remaining DLBCL patients with involved BM, the infiltration is due to the presence of small cells, resulting in "discordant" histology between the primary (nodal or extranodal) site and BM. Such cases of BM involvement are not independently associated with prognosis 4,7,8 and may reflect the presence of an underlying lowgrade lymphoma component, which is usually, but not always, of follicle-center cell origin.9 Such small cell BM populations are often, although not invariably, 9 clonally related to the original neoplastic DLBCL cell, and may potentially lead to a subsequent relapse that pursues a course resembling more to that of an indolent follicul...

show abstract

Impact of Concordant and Discordant Bone Marrow Involvement on Outcome in Diffuse Large B-Cell Lymphoma Treated With R-CHOP

Cited by 209 publications

References 22 publications

Pre-Treatment FDG PET Bone Marrow (BM) Uptake and Disease Involvement. Can Semiquantitative Measures Discriminate Between A Normal, Hypercellular or Infiltrated Bone Marrow?

Pre-Treatment FDG PET Bone Marrow (BM) Uptake and Disease Involvement. Can Semiquantitative Measures Discriminate Between A Normal, Hypercellular or Infiltrated Bone Marrow?

Non-Hodgkin lymphoma: the clinician's perspective—a view from the receiving end

Comment on "Rituximab maintenance for patients with aggressive B-cell lymphoma in first remission: results of the randomized NHL13 trial"

Contact Info

Product

Resources

About