PRIMARY NON-HODGKINS-LYMPHOMA OF BONE - A CLINICOPATHOLOGICAL STUDY

Background. This study relates our experience in the diagnosis and tre atment of a rare clinical entity, non-Hodgkin's primary lymphoma of bo ne. Methods. Seventeen cases of patients with primary lymphoma of bone diagnosed and treated at a single institution between 1975 and 1992 a re reviewed. Ten patients received combined-modality therapy, consisti ng of an anthracycline-containing combination chemotherapy (CT) regime n, followed by adjuvant radiotherapy (RT) to the primary site of disea se. Five patients were treated with CT alone; one patient received RT alone; and one patient was treated with CT after emergency RT for spin al cord compression. Results. Thirteen patients presented with Stage I disease, two with Stage II; and two with Stage IV disease (multiple b ony sites only). Thirteen patients had an intermediate-grade diffuse l arge cell lymphoma; two had an intermediate-grade mixed small and larg e cell lymphoma; and two had a high-grade lymphoma (one immunoblastic and one small non-cleaved cell lymphoma). The overall response rate wa s 94% (18% complete response, 58% partial response 1, and 18% partial response 2). Thirteen patients are alive and disease-free at a median of 29 months; 10 of these received CT + RT, and 3 received CT alone. T hree patients have died; one of these received CT + RT and one CT alon e, and one relapsed immediately after CT. One patient, who was initial ly treated with RT and then with CT + RT after relapse, was lost to fo llow-up 40 months from the start of treatment. Conclusions. Because ex perience in the literature suggests a 50% distant relapse rate in prim ary lymphoma of bone treated with RT alone, our policy is to treat all patients with combined-modality therapy (CT + RT). However, only a Ph ase III randomized, controlled clinical trial will determine whether C T + RT is superior to either modality alone.