Bone marrow histology in Waldenström's macroglobulinaemia. Clinical relevance of subtype recognition.
Bone marrow biopsies of 137 patients with Waldenström's macroglobulinaemia (WM), 26 with non-secretory immunocytoma and 32 with benign monoclonal gammopathy were processed for histologic evaluation. Bone marrow involvement was found in 110 (80%) initially, and in 24 (18%) in sequential biopsies. 3 types were distinguished: lymphoplasmacytoid (47%), lymphoplasmacytic (42%) and polymorphous (11%) with median survivals of 74, 25 and 12 months, respectively. When grouped according to the tumour cell mass in the biopsies, the median survivals were 55, 21 and 8 months for less than 20 vol%, 20-50 vol% and greater than 50 vol% respectively; in each subtype, the tumour cell mass correlated with the disease progression. 6 clinical variables were also found prognostically significant. These results demonstrate that (i) 98% of patients with WM have bone marrow involvement; (ii) the lymph node sub-classification is applicable to the bone marrow and has both clinical and prognostic significance; (iii) patients may be staged according to the tumour cell burden in the bone marrow biopsy.
D000328:Adult; D000368:Aged; D001853:Bone Marrow / Q000473:pathology*; D002471:Cell Transformation, Neoplastic / Q000145:classification / Q000473:pathology*; D003937:Diagnosis, Differential; D006801:Humans; D007119:Immunoblastic Lymphadenopathy / Q000097:blood / Q000145:classification / Q000473:pathology*; D007075:Immunoglobulin M / Q000032:analysis; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D008258:Waldenstrom Macroglobulinemia / Q000097:blood / Q000145:classification / Q000473:pathology*
D007075:Immunoglobulin M