Staging bone marrow in diffuse large B-cell lymphoma: the role of ancillary investigations

Talaulikar, Dipti; Dahlstrom, Jane E.

doi:10.1080/00313020902756295

Cited by 21 publications

(20 citation statements)

References 56 publications

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“…This variability may be related to adequacy of obtained hematopoietic tissue and precision of histopathological reporting [14]. Our results regarding primary site and presence of BM infiltration were not significantly different from findings in other reports.…”

Section: Discussioncontrasting

confidence: 50%

“…There are controversial data concerning the prognostic significance of BM involvement in DLBCL, when relying only on routine histology, percentage of medullar involvement, and type of infiltration [12,13]. Hence, some authors recommend determining BM involvement by other auxiliary methods such as flow cytometry and immunohistochemistry [14].…”

Section: Introductionmentioning

confidence: 99%

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Association of Morphology and Immunophenotype in Diffuse Large B-Cell Lymphomas with Bone Marrow Infiltration in a Sample Mexican Population

Romero-Guadarrama¹,

Ponce²,

Cruz³

et al. 2012

OJPathology

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Introduction: Diffuse large B-cell lymphoma (DLBCL), not otherwise specified, is a large B-cell lymphoma with a diffuse growth pattern and aggressive clinical course. It is divided in subgroups according to its morphology, immunophenotype, and primary site. Dissemination to bone marrow occurs in 11% to 35% of cases and can be of concordant or discordant morphology. Objective: To examine the association, the type of bone marrow involvement in relation to the primary site, morphology, immunohistochemistry of DLBCLs and to determine the cases of Epstein-Barr virus positive DLBCLs. Materials and Methods: We reviewed lymph node and extranodal biopsies as well as the respective bone marrow biopsies in all cases of DLBCL diagnosed in the Hospital General de México during the period from 2002 to 2010. We used immunohystochemistry for immunophenotype identification (Hans's algorithm) and an in-situ hybridization technique to detect presence of Epstein Barr encoded RNA (EBER). Results: We included 108 patients with a mean age of 51.9 years, 59 (55%) were men. DLBCL involved lymph nodes in 60% of cases and palatine tonsils in 13%. The centroblastic variant predominated (80%) and 58% originated from activated B-cells. Infiltration of bone marrow was present in 30% of cases and was discordant in 55% of these cases. Correlation between morphology and bone marrow infiltration was statistically significant (P = 0.0003). Presence of Epstein-Barr virus was demonstrated in 15% of patients older than 50 years. Conclusions: Dissemination to bone marrow occurred in 30% of cases and discordant involvement was most common. DLBCL originating from activated B-lymphocytes predominated and the most common extranodal sites were palatine tonsils, suggesting that our population has a clinical behavior similar to Asiatic populations.

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Section: Discussioncontrasting

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Association of Morphology and Immunophenotype in Diffuse Large B-Cell Lymphomas with Bone Marrow Infiltration in a Sample Mexican Population

Romero-Guadarrama¹,

Ponce²,

Cruz³

et al. 2012

OJPathology

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“…We defined monoclonality in this study as either a ratio of immunoglobulin light chain expression of kappa:lambda >3:1 or lambda:kappa >2:1 in at least 2% of the gated population. It should be acknowledged that other definitions for monoclonality are used in different studies and that some cases of DLBCL may not be light chain restricted . Although the previously mentioned characteristics may be potential limitations, the comparison of patient groups in our study was executed under similar diagnostic and therapeutic conditions.…”

Section: Discussionmentioning

confidence: 99%

“…The advent of more sensitive techniques such as flow cytometry (FC) and polymerase chain reaction (PCR) enables the recognition of occult involvement of disease in the BM of patients with lymphoma in the absence of overt histologic involvement. The rate of concordance between BM histology and FC is reported to be above 80% in most studies . Nevertheless, a small but measurable group of patients with cytometric BM involvement that is not demonstrated on routine histologic BM evaluation is frequently reported.…”

Section: Introductionmentioning

confidence: 98%

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

Wolach

Fraser

Luchiansky

et al. 2014

Hematological Oncology

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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.

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“…Previous studies show that these ancillary tests can improve the detection rate of BMI and predict the outcome of DLBCL patients. Among them, detection of monoclonal immunoglobulin gene rearrangement has been considered as an alternative tool for detecting minimal tumor cells . However, the implications of detecting monoclonal immunoglobulin gene rearrangement in conjunction with histologic B‐cell aggregates have not been robustly studied in terms of patient prognosis.…”

Section: Introductionmentioning

confidence: 99%

The prognostic significance of monoclonal immunoglobulin gene rearrangement in conjunction with histologic B‐cell aggregates in the bone marrow of patients with diffuse large B‐cell lymphoma

et al. 2016

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Bone marrow involvement (BMI) is a well‐known poor prognostic factor in patients with diffuse large B‐cell lymphoma (DLBCL). This study robustly investigated the significance of monoclonal immunoglobulin gene rearrangement combined with histologic B‐cell aggregates in bone marrow (BM) in the detection of a poor prognostic group. Pretreatment BM samples of 394 DLBCL patients were analyzed via the immunoglobulin gene rearrangement study and the microscopic examination. Monoclonal immunoglobulin gene rearrangement was detected in 25.4% of cases. Histologic B‐cell aggregates with the features of large B‐cell lymphoma aggregates, small cell B‐cell lymphoma aggregates, or B‐cell aggregates of unknown biological potential were observed in 12% of cases (6.9%, 1.3%, and 3.8%, respectively). Histologic B‐cell aggregates were more associated with monoclonality than polyclonality. Cases with both monoclonality and histologic B‐cell aggregates demonstrated close association with poor prognostic factors such as a higher International Prognostic Index score and showed an inferior overall survival rate when compared to cases with only monoclonality or only histologic B‐cell aggregates. From the findings, a combination of monoclonality and histologic B‐cell aggregates within the bone marrow was highly associated with poor prognosis and could be used to determine high‐risk DLBLC patients with greater sensitivity and specificity than conventional microscopic examination or immunoglobulin gene rearrangement study alone.

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Staging bone marrow in diffuse large B-cell lymphoma: the role of ancillary investigations

Cited by 21 publications

References 56 publications

Association of Morphology and Immunophenotype in Diffuse Large B-Cell Lymphomas with Bone Marrow Infiltration in a Sample Mexican Population

Association of Morphology and Immunophenotype in Diffuse Large B-Cell Lymphomas with Bone Marrow Infiltration in a Sample Mexican Population

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

The prognostic significance of monoclonal immunoglobulin gene rearrangement in conjunction with histologic B‐cell aggregates in the bone marrow of patients with diffuse large B‐cell lymphoma

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