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 Blood, 15 August 2007, Vol. 110, No. 4, pp. 1278-1282.
Prepublished online as a Blood First Edition Paper on May 2, 2007; DOI 10.1182/blood-2007-01-070300.

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NEOPLASIA

Concordant but not discordant bone marrow involvement in diffuse large B-cell lymphoma predicts a poor clinical outcome independent of the International Prognostic Index

Randy Chung1,4, Raymond Lai2,4, Peter Wei1,4, Jason Lee1,4, John Hanson3, Andrew R. Belch1,4, A. Robert Turner1,4, and Tony Reiman1,4

1 Department of Medical Oncology 2 Department of Pathology 3 Department of Epidemiology, Cross Cancer Institute; and 4 Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada

In diffuse large B-cell lymphoma (DLBCL), previous studies have suggested that, while concordant bone marrow (BM) involvement confers a poor prognosis, discordant BM involvement does not. Whether this correlation is independent of the non-Hodgkin lymphoma International Prognostic Index (IPI) was previously unknown. We reviewed all DLBCL case histories from 1986 to 1997 at our center with complete staging, IPI data, and follow-up. A total of 55 (11.2%) of 489 patients had BM involvement, including 29 with concordant involvement and 26 with discordant involvement. The 55 patients with BM involvement had a poor prognosis compared with the uninvolved BM group (5-year overall survival [OS], 34.5% versus 46.9%; log-rank P = .019). However, concordant involvement portended a very poor prognosis (5-year OS, 10.3%; P < .001), whereas discordant involvement did not (5-year OS, 61.5%, P value nonsignificant). Compared with the discordant subset, the concordant subset patients were older, had a higher serum lactate dehydrogenase level, and a significantly higher IPI. However, the poor survival associated with concordant BM involvement was independent of the IPI score (P = .002, Cox regression). We conclude that in patients with DLBCL, concordant but not discordant BM involvement confers a very poor clinical outcome. Furthermore, concordant BM involvement is an independent adverse prognostic factor.


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