FACTORS CONTRIBUTING TO THE PROGNOSTIC-SIGNIFICANCE OF BONE-MARROW INVOLVEMENT IN CHILDHOOD NON-HODGKIN-LYMPHOMA

To evaluate the clinical characteristics and treatment outcome of chil dhood non-Hodgkin lymphoma (NHL) cases with bone marrow involvement, w e studied 13 lymphoblastic, 15 small noncleaved cell, and 8 large cell cases with tumor cells in their marrow. They represented 16%, 11 %, a nd 9% of consecutive NHL cases with these respective histologic subtyp es. The treatment outcome differed significantly according to histolog ic subtype-the 5-year event-free survivals (EFS +/- SE) for large cell NHL, small non-cleaved cell NHL, and lymphoblastic NHL cases were 11 +/- 8%, 40 +/- 20%, and 62 +/- 15%, respectively. Increased serum lact ate dehydrogenase (LDH) levels (>500 U/L) were associated with a poore r EFS (5-year EFS, 0% vs. 50 +/- 10%; P <0.001). Children less-than-or -equal-to 5 years of age had a poorer EFS survival than older children (5-year EFS, 14 +/- 9% vs. 44 +/- 10%; P = 0.03). The degree of bone marrow involvement (<5% vs. greater-than-or-equal-to 5%) and race were not significantly associated with treatment outcome. Although intensi ve chemotherapy has substantially improved survival for patients with advanced stage lymphoblastic or small noncleaved cell lymphoma, patien ts with large cell NHL and associated marrow involvement continue to h ave a dismal outcome and require novel or more intensive therapy. (C) 1994 Wiley-Liss, Inc.