The prognostic impact of bone marrow involvement in patients with diffuse large cell lymphoma varies according to the degree of infiltration and presence of discordant marrow involvement

Campbell, Janine; Seymour, John F.; Matthews, Jane P.; Wolf, Max; Stone, Julius; Juneja, Surender

doi:10.1111/j.1600-0609.2006.00644.x

Cited by 105 publications

(84 citation statements)

References 23 publications

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“…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: 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

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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.

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Section: Discussionmentioning

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

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“…This is a higher degree of concordant involvement than has been reported by Chung et al (2007) (?50%) and Campbell et al (2006) (?28%) and may be caused by involvement being measured on IHC rather than routine histology. Although a trend toward better survival was noted with discordant rather than concordant involvement, this was not statistically significant and may be because of the small numbers, especially when cases treated with palliative intent were excluded.…”

Section: Discussionmentioning

confidence: 99%

“…Marrow involvement in DLBCL has implications for prognosis; lymphomatous infiltration in the marrow has been reported to correlate with poor survival (Yan et al 1995;Campbell et al 2006). Furthermore, marrow involvement in DLBCL affects the International Prognostic Index (IPI) both by increasing the stage of the disease to stage IV and by being assessed as extranodal involve ment (Shipp et al 1993).…”

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confidence: 99%

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Role of Immunohistochemistry in Staging Diffuse Large B-cell Lymphoma (DLBCL)

Talaulikar

Dahlstrom

Shadbolt

et al. 2008

J Histochem Cytochem.

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(AM) S U M M A R Y The use of immunohistochemistry (IHC) in staging bone marrow in nonHodgkin's lymphoma (NHL) is largely limited to ambiguous cases, particularly those with lymphoid aggregates. Its role in routine clinical practice remains unestablished. This study aimed to determine whether the routine use of IHC in diffuse large B-cell lymphoma (DLBCL) would improve the detection of lymphomatous involvement in the bone marrow. It also sought to determine the impact of IHC on predicting survival compared with routine histological diagnosis using hematoxylin and eosin (H&E), Giemsa, and reticulin staining. The bone marrow trephines of 156 histologically proven DLBCL cases were assessed on routine histology, and IHC using two T-cell markers (CD45RO and CD3), two B-cell markers (CD20 and CD79a), and k and l light chains. IHC detected lymphomatous involvement on an additional 11% cases compared with histology alone. Although both routine histology and IHC were good predictors of survival, IHC was better at predicting survival on stepwise multivariate Cox regression analysis. IHC performed routinely on bone marrow trephines has the ability to improve detection of occult lymphoma in experienced hands. Furthermore, it is a better predictor of survival compared with routine histological examination alone.

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“…Since the infiltration of lymphoma is usually focal, biopsy can miss the infiltration and the size of the biopsy may be too small to evaluate the infiltration. Although, some studies support the need for bilateral biopsies [4], others concluded that a specimen long enough (approximately 2 cm) may obviate the need for bilateral sampling [5].…”

Section: Introductionmentioning

confidence: 99%

The role of PET/CT in evaluation of bone marrow involvement in lymphoma patients at the initial staging

Yilmaz¹,

Soyer²,

Kiper³

et al. 2017

Marmara Medical Journal

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ÖZAmaç: Kemik iliği (Kİ) tutulumu, lenfoma hastalarında en önemli prognostik faktörlerden biridir. Bu nedenle, tanı anında Kİ tutulumunun gösterilmesi önemlidir.Kemik iliği biyopsisi (KİB) tutulumu göstermede altın standart kabul edilmesine rağmen invaziv ve ağrılı bir yöntemdir. Bu retrospektif çalışmada, tanı anında evreleme amacıyla çekilen PET/CT'nin Kİ tutulumunu göstermedeki yerini araştırdık.Hastalar ve Yöntemler : Tanı anında PET/CT ve KİB yapılan hastalar çalışmaya alındı.Bulgular: PET/CT'nin lenfoma hastalarının Kİ tutulumunu göstermedeki sensitivitesi %65.8, spesifisitesi ise %89.4 idi. Altgrup analizi yapıldığında; 176 Hodgkin lenfoma hastasında sensitivite %81 ve spesifisite %84 olarak bulundu. Negatif prediktif değer %98 idi. 201 diffüz büyük B hücreli lenfoma hastasında ise, sensitivite ve spesifisite sırasıyla %91.3 ve %94.3 idi. Negatif prediktif değer %98.8 olarak hesaplandı.Sonuç: PET/CT özellikle Hodgkin lenfoma ve difüz büyük B hücreli lenfoma hastalarında yüksek sensitivite ve spesifisitesi ile tamamlayıcı ve değerlendirilmesi gereken bir yöntemdir.

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The prognostic impact of bone marrow involvement in patients with diffuse large cell lymphoma varies according to the degree of infiltration and presence of discordant marrow involvement

Cited by 105 publications

References 23 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?

Role of Immunohistochemistry in Staging Diffuse Large B-cell Lymphoma (DLBCL)

The role of PET/CT in evaluation of bone marrow involvement in lymphoma patients at the initial staging

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