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Risk factors for poor treatment outcome and central nervous system relapse in diffuse large B-cell lymphoma with bone marrow involvement

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Abstract

Although several studies have described the prognostic implication of bone marrow (BM) involvement (BMI) in lymphoma, studies focused on BM-involved diffuse large B-cell lymphoma (DLBCL) are very rare and small-sized. This study was performed to examine the prognostic impact of morphologic findings of BMI by lymphoma and risk factors for central nervous system (CNS) relapse in BM-involved DLBCL. Between 1993 and 2005, 675 patients were diagnosed with DLBCL, and 88 patients who had BMI at initial diagnosis were eligible for this study. The median overall survival (OS) and failure-free survival (FFS) of 88 patients were 36.6 and 20.1 months, respectively. When three variables from BM morphologic findings (the pattern of BM infiltration, extent of BMI by lymphoma, and percentage of large cells in the infiltrate) were simultaneously included into multivariate model, the increased extent of BMI by lymphoma (≥10%) in BM area was the only negative prognostic factor, independent of the International Prognostic Index (IPI). Patients with both lower IPI scores and less extent of BMI showed an excellent prognosis with chemotherapy alone (5-year OS and FFS rates, 80% and 69%). However, morphologic BM features were not independent predictive factors for CNS recurrences. An increased lactate dehydrogenase (LDH) level at initial diagnosis was the only independent predictive factor for CNS relapse. Further efforts should be directed toward finding optimal treatment modalities based on the IPI and the extent of BMI by lymphoma. CNS prophylaxis may be considered only in patients with initial elevated LDH levels.

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Acknowledgements

We are grateful to Seo-Kyung Hahn of Medical Research Collaborating Center Seoul National University Hospital for her statistical assistance in the revision of this manuscript. This study was partially supported by a grant from the Innovative Research Institute for Cell Therapy, Republic of Korea (A062260).

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Authors and Affiliations

  1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea

    Keun-Wook Lee, In Sil Choi, Jee Hyun Kim, Soo-Mee Bang, Dong-Wan Kim, Seock-Ah Im, Tae-You Kim, Sung-Soo Yoon, Jong Seok Lee, Yung-Jue Bang, Seonyang Park, Byoung Kook Kim & Dae Seog Heo

  2. Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea

    Han Ik Cho

  3. Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea

    Dong-Wan Kim, Seock-Ah Im, Tae-You Kim, Sung-Soo Yoon, Yung-Jue Bang, Seonyang Park, Byoung Kook Kim & Dae Seog Heo

  4. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

    Keun-Wook Lee, Jee Hyun Kim, Soo-Mee Bang & Jong Seok Lee

  5. Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea

    Dong-Wan Kim, Seock-Ah Im, Tae-You Kim, Sung-Soo Yoon, Yung-Jue Bang, Seonyang Park, Byoung Kook Kim & Dae Seog Heo

  6. Department of Laboratory Medicine, Seoul National University Hospital, Seoul, South Korea

    Jongyoun Yi & Han Ik Cho

  7. Department of Internal Medicine, Seoul Municipal Boramae Hospital, Seoul, South Korea

    In Sil Choi

  8. Aerospace Medical Center, ROKAF, Cheongwon, Chungcheongbuk-do, South Korea

    Jongyoun Yi

  9. Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul, 110-744, South Korea

    Dae Seog Heo

Authors
  1. Keun-Wook Lee
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  2. Jongyoun Yi
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  3. In Sil Choi
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  4. Jee Hyun Kim
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  5. Soo-Mee Bang
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  6. Dong-Wan Kim
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  7. Seock-Ah Im
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  8. Tae-You Kim
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  9. Sung-Soo Yoon
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  10. Jong Seok Lee
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  11. Yung-Jue Bang
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  12. Seonyang Park
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  13. Byoung Kook Kim
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  14. Han Ik Cho
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  15. Dae Seog Heo
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Corresponding author

Correspondence to Dae Seog Heo.

Additional information

K.-W. Lee and J. Yi equally contributed to this study.

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Lee, KW., Yi, J., Choi, I.S. et al. Risk factors for poor treatment outcome and central nervous system relapse in diffuse large B-cell lymphoma with bone marrow involvement. Ann Hematol 88, 829–838 (2009). https://doi.org/10.1007/s00277-008-0682-6

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  • DOI: https://doi.org/10.1007/s00277-008-0682-6

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