Yan Y, Chan W C, Weisenburger D D, Anderson J R, Bast M A, Vose J M, Bierman P J, Armitage J O
Department of Internal Medicine, University of Nebraska Medical Center, Omaha 68198-3135, USA.
J Clin Oncol. 1995 Jun;13(6):1336-42. doi: 10.1200/JCO.1995.13.6.1336.
We studied the effect of morphology and extent of bone marrow (BM) infiltrate on the survival of patients with diffuse aggressive B-cell non-Hodgkin's lymphoma (NHL), along with clinical features.
Sixty adult patients with diffuse aggressive B-cell NHL and BM involvement at the time of presentation were studied. All patients were uniformly staged and treated with a curative high-dose chemotherapy regimen. BM involvement was assessed according to the cytology, pattern of infiltration, and extent of involvement, and was correlated with overall survival (OS) and failure-free survival (FFS).
Patients with BM involvement that consisted of > or = 50% large cells or BM involvement of > or = 70% had a poorer OS (P = .065 and P = .055, respectively). Those who presented with an infiltrate of less than 50% large cells and an international prognostic index (IPI) of < or = 3 had a significantly longer postrelapse survival time (P = .003). A diffuse or interstitial pattern of BM involvement was predictive of both poor OS and FFS (P = .008 and .009, respectively). Multivariate analysis indicated that only IPI (P = .0005) and pattern of BM infiltration (P = .009) were independent predictors of OS, and only the former was predictive of FFS (P = .03).
The IPI is predictive of OS and FFS, while BM involvement with a diffuse or interstitial pattern is associated with significantly poorer OS. Patients with BM infiltration that involved > or = 70% of the marrow or contained > or = 50% large cells had poor OS, but more patients need to be studied to determine the significance. Two parameters, IPI < or = 3 and BM large cells less than 50%, identify a group of patients with long-term survival after relapse.
我们研究了骨髓（BM）浸润的形态和范围对弥漫性侵袭性B细胞非霍奇金淋巴瘤（NHL）患者生存的影响，并结合临床特征进行分析。
研究了60例初诊时患有弥漫性侵袭性B细胞NHL且伴有骨髓受累的成年患者。所有患者均进行统一分期，并接受根治性大剂量化疗方案治疗。根据细胞学、浸润模式和受累范围评估骨髓受累情况，并将其与总生存期（OS）和无失败生存期（FFS）相关联。
骨髓受累由≥50%大细胞组成或骨髓受累≥70%的患者总生存期较差（分别为P = 0.065和P = 0.055）。那些大细胞浸润少于50%且国际预后指数（IPI）≤3的患者复发后生存期明显更长（P = 0.003）。骨髓受累的弥漫性或间质模式预示着总生存期和无失败生存期均较差（分别为P = 0.008和P = 0.009）。多因素分析表明，只有IPI（P = 0.0005）和骨髓浸润模式（P = 0.009）是总生存期的独立预测因素，只有前者是无失败生存期的预测因素（P = 0.03）。
IPI可预测总生存期和无失败生存期，而骨髓受累呈弥漫性或间质模式与明显较差的总生存期相关。骨髓浸润≥70%或含有≥50%大细胞的患者总生存期较差，但需要更多患者进行研究以确定其意义。两个参数，IPI≤3和骨髓大细胞少于50%，可识别出一组复发后长期生存的患者。
