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Blood, 15 October 2001, Vol. 98, No. 8, pp. 2358-2363
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Clinical, immunologic, and pathologic correlates of bone marrow
involvement in 291 patients with acquired immunodeficiency
syndrome-related lymphoma
Lasika Seneviratne,
Byron
M. Espina,
Bharat N. Nathwani,
Joel A. Chan,
Russell K. Brynes, and
Alexandra M. Levine
From the Departments of Medicine and Pathology, Keck
School of Medicine, University of Southern California, and the
University of Southern California/Norris Comprehensive Cancer
Center and Research Institute, Los Angeles.
Bone marrow involvement is reported in approximately 25% of
patients with newly diagnosed acquired immunodeficiency
syndrome-related lymphoma (ARL). Studied were 291 patients
with ARL, diagnosed and treated at one medical center between 1984 and
1998. Clinical, immunologic, and pathologic characteristics of
patients with bone marrow involvement were compared with those of
patients without marrow involvement. Bone marrow involvement was
present in 55 patients (19%). Small noncleaved lymphoma was diagnosed
in 38% of the entire group and was the most common pathologic subtype in patients with bone marrow involvement (55% versus 34%;
P = .008). Analysis of complete blood counts revealed a
median hemoglobin level of 10.6 g/dL in both marrow-positive and
marrow-negative groups. In contrast, a platelet count lower than
100 000/µL was more common in patients with bone marrow involvement
(27% versus 11%; P = .02). Patients with marrow
involvement were more likely to have leptomeningeal (cerebrospinal
fluid [CSF]) lymphoma than patients whose marrows were uninvolved
(24% versus 7%; P < .001) and were also more likely to
have high lactate dehydrogenase (LDH) (P = .002), bone
involvement (P < .001), and/or systemic B symptoms including fever, night sweats, and/or weight loss
(P = .05). Median survival did not differ between
marrow-positive and marrow-negative groups. On multivariate analysis,
factors associated with decreased survival of marrow-positive patients
included greater than 50% involvement (P = .002),
systemic B symptoms (P = .008), and high-grade histologic
type (P = .035). Marrow involvement in ARL correlates with small noncleaved pathology, thrombocytopenia lower than 100 000
mm3, high LDH, and lymphomatous involvement of the CSF.
Survival is statistically shorter in patients with greater than 50%
marrow involvement, high-grade pathology, and/or systemic B symptoms.
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