CLINICAL AND PROGNOSTIC-SIGNIFICANCE OF BONE-MARROW INVOLVEMENT IN PATIENTS WITH DIFFUSE AGGRESSIVE B-CELL LYMPHOMA

Purpose: 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. Pati ents and Methods: Sixty adult patients with diffuse aggressive B-cell NHL and BM involvement at the time of presentation were studied. All p atients were uniformly staged and treated with a curative high-dose ch emotherapy regimen. BM involvement was assessed according to the cytol ogy, pattern of infiltration, and extent of involvement, and was corre lated with overall survival (OS) and failure-free survival (FFS). Resu lts: Patients with BM involvement that consisted of greater than or eq ual to 50% large cells or BM involvement of greater than or equal to 7 0% had a poorer OS (P=.065 and P=.055, respectively). Those who presen ted with an infiltrate of less than 50% large cells and an internation al prognostic index (IPI) of less than or equal to 3 had a significant ly longer postrelapse survival time (P=.003). A diffuse or interstitia l pattern of BM involvement was predictive of both poor OS and FFS (P= .008 and .009, respectively). Multivariate analysis indicated that onl y IPI (P=.0005) and pattern of BM infiltration (P=.009) were independe nt predictors of OS, and only the former was predictive of FFS (P=.03) . Conclusion: The IPI is predictive of OS and FFS, while BM involvemen t with a diffuse or interstitial pattern is associated with significan tly poorer OS. Patients with BM infiltration that involved greater tha n or equal to 70% of the marrow or contained greater than or equal to 50% large cells had poor OS, but more patients need to be studied to d etermine the significance. Two parameters, IPI less than or equal to 3 and BM large cells less than 50%, identify a group of patients with l ong-term survival after relapse. (C) 1995 by American Society of Clini cal Oncology.