Submitted January 29, 2007
Accepted April 20, 2007
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 Chung, Raymond Lai, Peter Wei, Jason Lee, John Hanson, Andrew R. Belch, A. Robert Turner, and Tony Reiman*
Department of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Canada
Department of Pathology, Cross Cancer Institute, University of Alberta, Edmonton, Canada
Department of Epidemiology, Cross Cancer Institute, University of Alberta, Edmonton, Canada
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
* Corresponding author; email: tonyreim{at}cancerboard.ab.ca.
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 international non-Hodgkin's lymphoma prognostic index (IPI) was previously unknown. We reviewed all DLBCL cases from 1986-1997 at our center with complete staging, IPI data and follow-up. Fifty-five of 489 (11.2%) cases had BM involvement, including 29 with concordant involvement and 26 with discordant involvement. The 55 patients with BM involvement had a poor prognosis compared to the uninvolved BM group (5 year OS 34.5% versus 46.9%; log rank p=0.019). However, concordant involvement portended a very poor prognosis (5 year OS 10.3%, p<0.001) whereas discordant involvement did not (5 year OS 61.5%, p=NS). Compared to the discordant subset, the concordant subset 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=0.002, 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.
