THE BONE-MARROW INFILTRATION PATTERN IN B-CELL CHRONIC LYMPHOCYTIC-LEUKEMIA IS NOT AN IMPORTANT PROGNOSTIC FACTOR

In a multicentre study of 635 consecutive newly diagnosed patients wit h B-CLL, the histological bone marrow (BM) specimens were reviewed ind ependently by each of 3 pathologists and found evaluable for BM infilt ration pattern in 575 patients, 404 of whom had a CD5(+), mainly FMC7( -), faint surface-membrane immunoglobulin (SIg) fluorescence-intensity phenotype. In these 404 patients the following BM infiltration patter ns were found: mixed nodular-interstitial (30%), moderate interstitial (44%), heavy interstitial (20%) and diffuse packed (6%). In univariat e survival analysis, significant differences were found according to B M pattern (p<0.05), the presence of nodules being a favorable prognost ic sign. In multivariate survival analysis in a model including age, c linical stage, BM pattern, BM lymphocytosis, WBC and sex, only age and stage but not BM pattern or BM lymphocytosis had independent prognost ic significance. In stage A, progression-free survival was significant ly longer in patients with nodular than in patients with non-nodular b one-marrow pattern. The overall survival of these patients, however, d id not differ, possibly owing to the prompt and prolonged treatment gi ven to most patients at the time of progression to stage B or C. We co nclude that in CD5(+), SIg(faint), mainly FMC7(-) B-CLL, bone-marrow h istology may predict unstable disease in early clinical stage but is n ot important for treatment decisions, when these are based on clinical stage.