Journal of Clinical Oncology, Vol 9, 236-242, Copyright © 1991 by American Society of Clinical Oncology
Discordant bone marrow involvement in diffuse large-cell lymphoma: a distinct clinical-pathologic entity associated with a continuous risk of relapse
LE Robertson, JR Redman, JJ Butler, BM Osborne, WS Velasquez, P McLaughlin, F Swan, MA Rodriguez, FB Hagemeister and LM Fuller
Department of Hematology, University of Texas MD Anderson Cancer Center, Houston.
From 1975 to 1988, 50 patients with lymph node biopsy-documented diffuse
large-cell lymphoma (DLCL) presented with bone marrow involvement.
Twenty-four patients (48%) had large-cell lymphoma (LCL) in the bone marrow
and were compared with 19 (38%) patients who had small cleaved-cell
lymphoma (SCCL) in the marrow. Additionally, seven patients (14%) had mixed
small- and large-cell lymphoma (ML) in the marrow. Patients who had LCL
marrow involvement were younger (P less than .02) and more frequently had
elevated lactic dehydrogenase (LDH) levels (P less than .001), high tumor
burden (P less than .01), and more sites of extranodal disease (P less than
.05) than those with SCCL in the marrow. The complete response (CR) rate to
multiagent chemotherapy was 16.7% in the LCL group and 89.4% in the SCCL
group (P less than .001). One third of the patients with LCL in the marrow
developed CNS involvement, compared with only one patient in the SCCL group
(P = .06). Overall 5-year survival was 79% in patients with SCCL marrow
involvement, compared with only 12% in patients with LCL in the marrow (P =
.002). Despite a high CR rate, patients with marrow involved by SCCL were
at a high continuous risk of relapse with only a 30% failure-free survival
at 5 years. We conclude that bone marrow involvement with LCL predicts for
extremely poor prognosis with low response rate and short survival.
Patients with SCCL in the bone marrow have a high rate of CR and a high
rate of 5-year survival; however, there is a high risk of late relapse, and
only 15% are in a continuous remission at 8 years.
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