如果在骨髓中，是否也在血液中？对 1000 例 B 细胞非霍奇金淋巴瘤患者配对样本的分析。

If it is in the marrow, is it also in the blood? An analysis of 1,000 paired samples from patients with B-cell non-Hodgkin lymphoma.

机构信息

Laboratory of Hematology-Oncology, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy.

出版信息

BMC Cancer. 2010 Nov 24;10:644. doi: 10.1186/1471-2407-10-644.

DOI:10.1186/1471-2407-10-644

PMID:21106070

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2995803/

Abstract

BACKGROUND

Staging of B-cell non Hodgkin's lymphoma (NHL) routinely involves bone marrow (BM) examination by trephine biopsy (BM-TB). The evidence of disease in the BM-TB results in a clinical stage IV classification affecting therapeutic strategies for NHL patients. BM immunophenotyping by flow cytometry (FC) is also used, although its clinical value is still under debate.

METHODS

Using FC we analyzed 1,000 paired BM aspirates and peripheral blood (PB) samples from 591 NHL patients to investigate the concordance between BM and PB. B-lymphocytes were defined monoclonal when a ratio of 0.3 < κ/l > 3 was observed. Aberrant immunophenotypes present in the B-cell subpopulation were also investigated. BM-TB was also performed in 84.1% of samples (841/1000), and concordance between BM-TB and BM-FC was evaluated. Concordance was defined as the presence of a positive (in terms of disease detection) or negative result in both BM-FC and PB-FC or BM-TB and BM-FC.

RESULTS

Using FC, the overall concordance between BM and PB was 95%. Among the discordant cases (ie presence of neoplastic B-lymphocyte in the BM but under the sensibility of the technique in the PB) the most frequent diagnosis was Waldenstrom's macroglobulinemia (WM, accounting for 20.8% of all discordant cases). The expression of CXCR4, a receptor involved in B-cell trafficking and homing, was found to be down regulated in WM compared to other NHL types, thus suggesting a possible role of CXCR4 in WM cell homing in the BM. WM excluded, FC investigation of BM and PB in NHL patients gives overlapping information.BM involvement was observed by FC in 38% of samples, and concordance between BM-FC and BM-TB was 85%.

CONCLUSIONS

The finding that FC data from BM and PB samples overlap in NHL might have major implications for the design of future clinical studies and for patients' follow-up.

摘要

背景

B 细胞非霍奇金淋巴瘤（NHL）的分期通常包括通过骨髓（BM）活检进行骨髓（BM）检查。BM-TB 结果中的疾病证据导致 IV 期临床分类，影响 NHL 患者的治疗策略。流式细胞术（FC）也用于 BM 免疫表型分析，尽管其临床价值仍存在争议。

方法

我们使用 FC 分析了 591 例 NHL 患者的 1000 对 BM 抽吸物和外周血（PB）样本，以研究 BM 和 PB 之间的一致性。当观察到 0.3 <κ/l<3 的比例时，B 淋巴细胞被定义为单克隆。还研究了 B 细胞亚群中存在的异常免疫表型。84.1%的样本（841/1000）进行了 BM-TB，评估了 BM-TB 和 BM-FC 之间的一致性。一致性定义为 BM-FC 和 PB-FC 或 BM-TB 和 BM-FC 中均存在阳性（以检测疾病）或阴性结果。

结果

使用 FC，BM 和 PB 之间的总体一致性为 95%。在不一致的病例（即 BM 中存在肿瘤性 B 淋巴细胞，但在 PB 技术的敏感性下）中，最常见的诊断是 Waldenstrom 巨球蛋白血症（WM，占所有不一致病例的 20.8%）。与其他 NHL 类型相比，WM 中 CXCR4 受体的表达下调，该受体参与 B 细胞的迁移和归巢，这表明 CXCR4 可能在 WM 细胞归巢到 BM 中发挥作用。WM 除外，FC 对 NHL 患者的 BM 和 PB 进行检查可提供重叠信息。FC 观察到 38%的样本存在 BM 受累，BM-FC 和 BM-TB 之间的一致性为 85%。