title: Occult bone marrow involvement in patients with diffuse large B-cell lymphoma: results of a pilot study.
abstract: OBJECTIVE
  It is known that advanced stage disease in diffuse large B-cell lymphoma (DLBCL) confers a poor prognosis, and staging investigations are routinely performed at diagnosis, including a bone marrow (BM) biopsy. However, examination of the BM is usually limited to routine light microscopy, with the role of ancillary investigations remaining unestablished. The aim of this pilot study was to estimate the incidence of occult marrow involvement using flow cytometry, immunohistochemistry and immunoglobulin heavy chain (IgH) gene rearrangements, and to determine the impact on survival.
  
  
  METHODS
  Clinical and pathological data were obtained on 36 patients diagnosed with DLBCL. Immunohistochemistry using CD3, CD45RO, CD20 and CD79a, and polymerase chain reaction (PCR) to look for IgH gene rearrangements were performed on formalin fixed BM trephines.
  
  
  RESULTS
  Nine patients had morphologically apparent BM involvement. Occult marrow involvement was found in seven of 36 (19.4%) patients using the additional diagnostic modalities. When these cases were included with morphologically apparent cases in a proposed new definition of marrow involvement, the median survival of patients with BM involvement was statistically worse (p=0.02) than those without involvement.
  
  
  CONCLUSIONS
  The results indicate that use of additional tests on BM at diagnosis can upstage disease for a proportion of patients, which appears to correlate adversely with survival.
authors.affiliation: Department of Haematology, The Canberra Hospital, Australian Capital Territory, Australia. dipti.talaulikar@act.gov.au
authors.forename: Dipti
authors.initials: D
authors.lastname: Talaulikar
authors.forename: Jane E
authors.initials: JE
authors.lastname: Dahlstrom
authors.forename: Bruce
authors.initials: B
authors.lastname: Shadbolt
authors.forename: Michelle
authors.initials: M
authors.lastname: McNiven
authors.forename: Amy
authors.initials: A
authors.lastname: Broomfield
authors.forename: Michael
authors.initials: M
authors.lastname: Pidcock
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D001853:Bone Marrow / Q000737:chemistry / Q000473:pathology*; D001854:Bone Marrow Cells / Q000737:chemistry / Q000473:pathology*; D004273:DNA, Neoplasm / Q000032:analysis; D005260:Female; D005434:Flow Cytometry; D015322:Gene Rearrangement, B-Lymphocyte; D006801:Humans; D007150:Immunohistochemistry; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010865:Pilot Projects; D011379:Prognosis; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D004273:DNA, Neoplasm