Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver Clinic, 600 W 10th Ave, Vancouver, British Columbia, Canada V5Z 4E6.
J Clin Oncol. 2011 Apr 10;29(11):1452-7. doi: 10.1200/JCO.2010.33.3419. Epub 2011 Mar 7.
In diffuse large B-cell lymphoma (DLBCL), prior studies suggest that concordant bone marrow involvement with DLBCL portends a poorer prognosis, whereas discordant bone marrow involvement with small B-cell lymphoma does not. We examined the significance of bone marrow involvement in patients treated in the current era of therapy including rituximab.
We performed a retrospective analysis of the prognostic impact of bone marrow involvement in an unselected population of patients with newly diagnosed DLBCL treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone in British Columbia and Auckland, New Zealand, with complete clinical information and evaluable staging bone marrow biopsies.
In total, 795 patients were identified. Six hundred seventy (84.3%) of 795 had a negative bone marrow, 67 patients (8.4%) had concordant and 58 (7.3%) had discordant involvement. Median follow-up was 41 months (range, 1 to 115). Progression-free survival (PFS) was inferior in those with concordant (P < .001) and discordant (P = .019) involvement while overall survival (OS) was inferior in those with concordant involvement (P < .001) only. In a multivariate analysis controlling for the International Prognostic Index (IPI) score, concordant involvement remained an independent predictor of PFS (P < .001) and OS (P = .007). Discordant involvement was associated with older age, elevated lactate dehydrogenase, advanced stage, and increased number of extranodal sites and was not a negative prognostic factor independent of the IPI score.
The negative prognostic impact of discordant involvement is adequately represented by the IPI score, while the risk with concordant involvement is greater than that encompassed by this predictor. The results emphasize the need for accurate staging assessment of bone marrow involvement in DLBCL.
在弥漫性大 B 细胞淋巴瘤（DLBCL）中，先前的研究表明，与 DLBCL 一致的骨髓受累预示着预后较差，而与小 B 细胞淋巴瘤不一致的骨髓受累则不会。我们研究了在当前包括利妥昔单抗在内的治疗时代，骨髓受累对接受治疗的患者的意义。
我们对不列颠哥伦比亚省和新西兰奥克兰接受利妥昔单抗联合环磷酰胺、多柔比星、长春新碱和泼尼松治疗的新诊断为 DLBCL 的患者进行了回顾性分析，这些患者具有完整的临床信息和可评估的分期骨髓活检。
共确定了 795 例患者。795 例患者中，670 例（84.3%）骨髓阴性，67 例（8.4%）骨髓与疾病一致，58 例（7.3%）骨髓与疾病不一致。中位随访时间为 41 个月（范围 1 至 115 个月）。在那些骨髓与疾病一致（P <.001）和不一致（P =.019）的患者中，无进展生存（PFS）较差，而在那些骨髓与疾病一致的患者中，总生存（OS）较差（P <.001）。在多变量分析中，控制国际预后指数（IPI）评分后，骨髓与疾病一致仍然是 PFS（P <.001）和 OS（P =.007）的独立预测因素。骨髓与疾病不一致与年龄较大、乳酸脱氢酶升高、晚期疾病、更多的结外部位有关，且与 IPI 评分无关，并非独立的预后不良因素。
不一致的骨髓受累的预后不良影响通过 IPI 评分得到充分体现，而与疾病一致的骨髓受累的风险大于该预测指标所包含的风险。结果强调了准确分期评估 DLBCL 骨髓受累的必要性。
