Kim Yu Ri, Shin Ho Jin, Yhim Ho-Young, Yang Deok-Hwan, Park Yong, Lee Ji Hyun, Lee Won-Sik, Do Young Rok, Mun Yeung-Chul, Kim Dae Sik, Kim Jin Seok
Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea.
Division of Haematology-Oncology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea.
Front Oncol. 2024 Feb 12;14:1363385. doi: 10.3389/fonc.2024.1363385. eCollection 2024.
Bone marrow (BM) involvement is an indicator of a poor prognosis in diffuse large B-cell lymphoma (DLBCL); however, few studies have evaluated the role of immunoglobulin gene rearrangement (IgR) in detecting BM involvement.
We evaluated the clinical characteristics and treatment outcomes of patients with DLBCL based on histological BM involvement or positive BM IgR using polymerase chain reaction or next-generation sequencing. We also investigated the role of consolidative upfront autologous hematopoietic stem cell transplantation (ASCT) in patients with DLBCL and BM involvement.
Among 624 patients, 123 (19.7%) with histological BM involvement and 88 (17.5%) with positive IgR in histologically negative BM had more advanced disease characteristics. Overall (OS) and progression-free (PFS) survival was better for patients with negative BM histology and negative IgR than that in patients with histological BM involvement ( = 0.050 and < 0.001, respectively) and positive IgR with negative BM histology ( = 0.001 and = 0.005, respectively). Survival rates did not differ among 82 (13.1%) patients who were treated with upfront ASCT and had histological BM involvement or positive IgR with negative BM histology. The survival outcomes were worse for patients who were not treated with upfront ASCT and for those with histological BM involvement or positive IgR, than for those with negative BM histology and negative IgR.
Patients diagnosed with DLBCL and BM involvement based on histology or IgR had aggressive clinical features and poor survival. Upfront ASCT mitigated poor prognosis due to BM involvement.
骨髓（BM）受累是弥漫性大B细胞淋巴瘤（DLBCL）预后不良的一个指标；然而，很少有研究评估免疫球蛋白基因重排（IgR）在检测BM受累中的作用。
我们基于组织学BM受累情况或使用聚合酶链反应或下一代测序检测到的BM IgR阳性，评估了DLBCL患者的临床特征和治疗结果。我们还研究了巩固性前期自体造血干细胞移植（ASCT）在DLBCL和BM受累患者中的作用。
在624例患者中，123例（19.7%）有组织学BM受累，88例（17.5%）在组织学阴性的BM中IgR阳性，这些患者具有更晚期的疾病特征。BM组织学阴性且IgR阴性的患者的总生存期（OS）和无进展生存期（PFS）优于有组织学BM受累的患者（分别为P = 0.050和P < 0.001）以及BM组织学阴性但IgR阳性的患者（分别为P = 0.001和P = 0.005）。82例（13.1%）接受前期ASCT且有组织学BM受累或BM组织学阴性但IgR阳性的患者的生存率没有差异。未接受前期ASCT的患者以及有组织学BM受累或IgR阳性的患者的生存结果比BM组织学阴性且IgR阴性的患者更差。
基于组织学或IgR诊断为DLBCL且BM受累的患者具有侵袭性临床特征且生存较差。前期ASCT减轻了因BM受累导致的不良预后。
