title: Clinical and prognostic significance of bone marrow involvement in patients with diffuse aggressive B-cell lymphoma.
abstract: OBJECTIVE
  We studied the effect of morphology and extent of bone marrow (BM) infiltrate on the survival of patients with diffuse aggressive B-cell non-Hodgkin's lymphoma (NHL), along with clinical features.
  
  
  METHODS
  Sixty adult patients with diffuse aggressive B-cell NHL and BM involvement at the time of presentation were studied. All patients were uniformly staged and treated with a curative high-dose chemotherapy regimen. BM involvement was assessed according to the cytology, pattern of infiltration, and extent of involvement, and was correlated with overall survival (OS) and failure-free survival (FFS).
  
  
  RESULTS
  Patients with BM involvement that consisted of > or = 50% large cells or BM involvement of > or = 70% had a poorer OS (P = .065 and P = .055, respectively). Those who presented with an infiltrate of less than 50% large cells and an international prognostic index (IPI) of < or = 3 had a significantly longer postrelapse survival time (P = .003). A diffuse or interstitial pattern of BM involvement was predictive of both poor OS and FFS (P = .008 and .009, respectively). Multivariate analysis indicated that only IPI (P = .0005) and pattern of BM infiltration (P = .009) were independent predictors of OS, and only the former was predictive of FFS (P = .03).
  
  
  CONCLUSIONS
  The IPI is predictive of OS and FFS, while BM involvement with a diffuse or interstitial pattern is associated with significantly poorer OS. Patients with BM infiltration that involved > or = 70% of the marrow or contained > or = 50% large cells had poor OS, but more patients need to be studied to determine the significance. Two parameters, IPI < or = 3 and BM large cells less than 50%, identify a group of patients with long-term survival after relapse.
authors.affiliation: Department of Internal Medicine, University of Nebraska Medical Center, Omaha 68198-3135, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Yan
authors.forename: W C
authors.initials: WC
authors.lastname: Chan
authors.forename: D D
authors.initials: DD
authors.lastname: Weisenburger
authors.forename: J R
authors.initials: JR
authors.lastname: Anderson
authors.forename: M A
authors.initials: MA
authors.lastname: Bast
authors.forename: J M
authors.initials: JM
authors.lastname: Vose
authors.forename: P J
authors.initials: PJ
authors.lastname: Bierman
authors.forename: J O
authors.initials: JO
authors.lastname: Armitage
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001855:Bone Marrow Diseases / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D016393:Lymphoma, B-Cell / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016019:Survival Analysis