PERIPHERAL-BLOOD INVOLVEMENT IN NON-HODGKINS-LYMPHOMA DETECTED BY CLONAL GENE REARRANGEMENT AS A BIOLOGICAL PROGNOSTIC MARKER

Peripheral blood from 67 patients with non-Hodgkin's lymphoma was exam ined at initial diagnosis for the presence of circulating lymphoma cel ls by DNA hybridisation using immunoglobulin and T-cell receptor gene probes. Clonal gene rearrangement was found in 31% (21/67) of patients and correlated with clinical stage, histological grade and bone marro w involvement. Clinical stage and the presence of lymphoma cells in pe ripheral blood were prognostic factors for progression-free survival i n all patients on univariate analysis, but the detection of lymphoma c ells was not independent of stage. It was also not a significant predi ctor for survival. In patients with intermediate- and high-grade lymph oma, the detection of lymphoma cells in peripheral brood was a signifi cant prognostic factor for progression-free survival (PFS) and surviva l only on univariate analysis. The 3-year PFS was 17% in patients with circulating lymphoma cells compared with 75% if these were absent (P< 0.05). The presence of lymphoma cells in peripheral blood is associate d with extensive disease and may be a biological marker of poor diseas e control. Sensitive techniques of detection should form part of large prospective studies in non-Hodgkin's lymphoma.