title: Stage I/II follicular lymphoma: spread of bcl-2/IgH+ cells in blood and bone marrow from primary site of disease and possibility of clearance after involved field radiotherapy.
abstract: Stage I/IIA follicular lymphoma (FL) is considered a localised disease that can be adequately treated with radiotherapy alone. Bone marrow (BM) and peripheral blood (PB) involvement in FL was investigated by polymerase chain reaction (PCR) in a series of 24 consecutive patients with histologically revised diagnosis and treated with involved field radiotherapy. Despite the limited stage, Bcl-2/IgH+ cells were found at diagnosis in PB and/or BM of 16 patients (66.6%). After treatment, in 9/15 Bcl-2/IgH positive evaluable patients, a disappearance of Bcl-2/IgH+ cells was observed, which persisted after a median follow-up of 43.5 months (range 11-70) in all but one patient. Quantitative PCR demonstrated the feasibility of clearing PB and BM Bcl-2+ cells after local irradiation of the primary site of the disease only when the basal number of lymphoma cells was <1:100 000. Patients with Bcl-2/IgH+ cells at diagnosis or after treatment had a higher likelihood of relapse. Thus, despite a negative BM biopsy, the majority of localised FL Bcl-2/IgH+ cells were found in the PB and BM. Lymphoma cells can reversibly spread from the affected lymph node to PB and BM and, in a proportion of cases, durably disappear after irradiation. The possibility of a persistent lymphoma cell clearance is proportional to the amount of cells detected at presentation by quantitative PCR.
authors.affiliation: Division of Haematology, Dipartimento di Biotecnologie Cellulari ed Ematologia, "La Sapienza" University, Rome, Italy. masa.pth2@tmd.ac.jp
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pulsoni
authors.forename: Irene Della
authors.initials: ID
authors.lastname: Starza
authors.forename: Natalia
authors.initials: N
authors.lastname: Frattarelli
authors.forename: Emanuela
authors.initials: E
authors.lastname: Ghia
authors.forename: Emanuela
authors.initials: E
authors.lastname: Carlotti
authors.forename: Elena
authors.initials: E
authors.lastname: Cavalieri
authors.forename: Angela
authors.initials: A
authors.lastname: Matturro
authors.forename: Settimio
authors.initials: S
authors.lastname: Tempera
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rambaldi
authors.forename: Robin
authors.initials: R
authors.lastname: Foà
mesh_terms: D000328:Adult; D000368:Aged; D001853:Bone Marrow / Q000473:pathology*; D001854:Bone Marrow Cells / Q000473:pathology; D005260:Female; D019254:Genes, bcl-2 / Q000235:genetics*; D006801:Humans; D008224:Lymphoma, Follicular / Q000235:genetics / Q000503:physiopathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016133:Polymerase Chain Reaction / Q000379:methods