Clinical, immunologic, and pathologic correlates of bone marrow involvement in 291 patients with acquired immunodeficiency syndrome-related lymphoma

Bone marrow involvement is reported in approximately 25% of patients with n ewly diagnosed acquired immunodeficiency syndrome-related lymphoma (ARL). S tudied were 291 patients with ARL, diagnosed and treated at one medical cen ter between 1984 and 1998. Clinical, immunologic, and pathologic characteri stics of patients with bone marrow involvement were compared with those of patients without marrow involvement. Bone marrow involvement was present in 55 patients (19%). Small noncleaved lymphoma was diagnosed in 38% of the e ntire group and was the most common pathologic subtype in patients with bon e marrow involvement (55% versus 34%; P =.008). Analysis of complete blood counts revealed a median hemoglobin level of 10.6 g/dL in both marrow-posit ive and marrow-negative groups. In contrast, a platelet count lower than 10 0 000/muL was more common in patients with bone marrow involvement (27% ver sus 11%; P =.02). Patients with marrow involvement were more likely to have leptomeningeal (cerebrospinal fluid [CSF]) lymphoma than patients whose ma rrows were uninvolved (24% versus 7%; P <.001) and were also more likely to have high lactate dehydrogenase (LDH) (P=.002), bone involvement (P<.001), and/or systemic B symptoms including fever, night sweats, and/or weight lo ss (P=.05). Median survival did not differ between marrow-positive and marr ow-negative groups. On multivariate analysis, factors associated with decre ased survival of marrow-positive patients included greater than 50% involve ment (P =.002), systemic B symptoms (P =.008), and high-grade histologic ty pe (P=.035). Marrow involvement in ARL correlates with small noncleaved pat hology, thrombocytopenia lower than 100 000 mm(3), high LDH, and lymphomato us involvement of the CSF Survival is statistically shorter in patients wit h greater than 50% marrow involvement, high-grade pathology, and/or systemi c B symptoms. (C) 2001 by The American Society of Hematology.