Biological Features and Prognostic Impact of Bone Marrow Infiltration in Patients with Diffuse Large B-cell Lymphoma
The biology and clinical impact of bone marrow (BM) infiltration in patients with diffuse large B-cell lymphoma (DLBCL) remains unclear in the rituximab era. We retrospectively analyzed 232 patients diagnosed with DLBCL at our center between 1999 and 2014. Concordant-presence of large cells similar...
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MDPI AG
2020-02-01
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Series: | Cancers |
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Online Access: | https://www.mdpi.com/2072-6694/12/2/474 |
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record_format |
Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Sara Alonso-Álvarez Miguel Alcoceba María García-Álvarez Oscar Blanco Marta Rodríguez Mónica Baile Juan Carlos Caballero Julio Dávila María Belén Vidriales Carmen Esteban Piedad Arias Luis G. Díaz Pilar Tamayo María Dolores Caballero Norma C. Gutiérrez Marcos González Alejandro Martín |
spellingShingle |
Sara Alonso-Álvarez Miguel Alcoceba María García-Álvarez Oscar Blanco Marta Rodríguez Mónica Baile Juan Carlos Caballero Julio Dávila María Belén Vidriales Carmen Esteban Piedad Arias Luis G. Díaz Pilar Tamayo María Dolores Caballero Norma C. Gutiérrez Marcos González Alejandro Martín Biological Features and Prognostic Impact of Bone Marrow Infiltration in Patients with Diffuse Large B-cell Lymphoma Cancers bone marrow involvement diffuse large b-cell lymphoma discordant bone marrow concordant bone marrow cns relapse |
author_facet |
Sara Alonso-Álvarez Miguel Alcoceba María García-Álvarez Oscar Blanco Marta Rodríguez Mónica Baile Juan Carlos Caballero Julio Dávila María Belén Vidriales Carmen Esteban Piedad Arias Luis G. Díaz Pilar Tamayo María Dolores Caballero Norma C. Gutiérrez Marcos González Alejandro Martín |
author_sort |
Sara Alonso-Álvarez |
title |
Biological Features and Prognostic Impact of Bone Marrow Infiltration in Patients with Diffuse Large B-cell Lymphoma |
title_short |
Biological Features and Prognostic Impact of Bone Marrow Infiltration in Patients with Diffuse Large B-cell Lymphoma |
title_full |
Biological Features and Prognostic Impact of Bone Marrow Infiltration in Patients with Diffuse Large B-cell Lymphoma |
title_fullStr |
Biological Features and Prognostic Impact of Bone Marrow Infiltration in Patients with Diffuse Large B-cell Lymphoma |
title_full_unstemmed |
Biological Features and Prognostic Impact of Bone Marrow Infiltration in Patients with Diffuse Large B-cell Lymphoma |
title_sort |
biological features and prognostic impact of bone marrow infiltration in patients with diffuse large b-cell lymphoma |
publisher |
MDPI AG |
series |
Cancers |
issn |
2072-6694 |
publishDate |
2020-02-01 |
description |
The biology and clinical impact of bone marrow (BM) infiltration in patients with diffuse large B-cell lymphoma (DLBCL) remains unclear in the rituximab era. We retrospectively analyzed 232 patients diagnosed with DLBCL at our center between 1999 and 2014. Concordant-presence of large cells similar to those of the lymph node biopsy- and discordant-infiltration by small cells forming lymphoid aggregates, lacking cytological atypia-BM infiltration was defined by histological criteria and further characterized by flow cytometry (FCM). Cell of origin (COO) was determined using Hans’ algorithm. For the clonal relationship between tumor and discordant BM, the VDJH rearrangement was analyzed. Survival analyses were restricted to 189 patients treated with rituximab and chemotherapy. Thirty-six (16%) had concordant, and 37 (16%) discordant BM infiltration. FCM described different indolent lymphomas among discordant cases, clonally related with DLBCL in 10/13 available samples. Median follow-up was 58 months. 5-year-progression-free survival (PFS) for non-infiltrated, discordant and concordant groups was 68%, 65% and 30%, respectively (<i>p</i> < 0.001). Combining COO and BM infiltration, patients with discordant BM and non-germinal center B-cell COO also had decreased 5-year-PFS (41.9%). In multivariate analysis, concordant BM had an independent effect on PFS (HR 2.5, <i>p</i> = 0.01). Five-year cumulative incidence of central nervous system (CNS) relapse was 21%, 4% and 1% in concordant, discordant and non-infiltrated groups, respectively (<i>p</i> < 0.001). In conclusion, concordant BM infiltration represents a subset with poor prognosis, whereas the prognostic impact of discordant BM infiltration could be limited to non-CGB cases. |
topic |
bone marrow involvement diffuse large b-cell lymphoma discordant bone marrow concordant bone marrow cns relapse |
url |
https://www.mdpi.com/2072-6694/12/2/474 |
work_keys_str_mv |
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doaj-27e328c0914244d3be40dac9bd3f76792020-11-25T02:36:04ZengMDPI AGCancers2072-66942020-02-0112247410.3390/cancers12020474cancers12020474Biological Features and Prognostic Impact of Bone Marrow Infiltration in Patients with Diffuse Large B-cell LymphomaSara Alonso-Álvarez0Miguel Alcoceba1María García-Álvarez2Oscar Blanco3Marta Rodríguez4Mónica Baile5Juan Carlos Caballero6Julio Dávila7María Belén Vidriales8Carmen Esteban9Piedad Arias10Luis G. Díaz11Pilar Tamayo12María Dolores Caballero13Norma C. Gutiérrez14Marcos González15Alejandro Martín16Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC, and Cancer Research Institute of Salamanca-IBMCC (CSIC-USAL University), 37007 Salamanca, SpainDepartment of Hematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC, and Cancer Research Institute of Salamanca-IBMCC (CSIC-USAL University), 37007 Salamanca, SpainDepartment of Hematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC, and Cancer Research Institute of Salamanca-IBMCC (CSIC-USAL University), 37007 Salamanca, SpainDepartment of Pathology, University Hospital of Salamanca (HUS/IBSAL), 37007 Salamanca, SpainDepartment of Pathology, University Hospital of Salamanca (HUS/IBSAL), 37007 Salamanca, SpainDepartment of Hematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC, and Cancer Research Institute of Salamanca-IBMCC (CSIC-USAL University), 37007 Salamanca, SpainDepartment of Hematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC, and Cancer Research Institute of Salamanca-IBMCC (CSIC-USAL University), 37007 Salamanca, SpainDepartment of Hematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC, and Cancer Research Institute of Salamanca-IBMCC (CSIC-USAL University), 37007 Salamanca, SpainDepartment of Hematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC, and Cancer Research Institute of Salamanca-IBMCC (CSIC-USAL University), 37007 Salamanca, SpainDepartment of General and Gastrointestinal Surgery, University Hospital of Salamanca (HUS/IBSAL), 37007 Salamanca, SpainDepartment of Radiology, University Hospital of Salamanca (HUS/IBSAL), 37007 Salamanca, SpainDepartment of Nuclear Medicine, University Hospital of Salamanca (HUS/IBSAL), 37007 Salamanca, SpainDepartment of Nuclear Medicine, University Hospital of Salamanca (HUS/IBSAL), 37007 Salamanca, SpainDepartment of Hematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC, and Cancer Research Institute of Salamanca-IBMCC (CSIC-USAL University), 37007 Salamanca, SpainDepartment of Hematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC, and Cancer Research Institute of Salamanca-IBMCC (CSIC-USAL University), 37007 Salamanca, SpainDepartment of Hematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC, and Cancer Research Institute of Salamanca-IBMCC (CSIC-USAL University), 37007 Salamanca, SpainDepartment of Hematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC, and Cancer Research Institute of Salamanca-IBMCC (CSIC-USAL University), 37007 Salamanca, SpainThe biology and clinical impact of bone marrow (BM) infiltration in patients with diffuse large B-cell lymphoma (DLBCL) remains unclear in the rituximab era. We retrospectively analyzed 232 patients diagnosed with DLBCL at our center between 1999 and 2014. Concordant-presence of large cells similar to those of the lymph node biopsy- and discordant-infiltration by small cells forming lymphoid aggregates, lacking cytological atypia-BM infiltration was defined by histological criteria and further characterized by flow cytometry (FCM). Cell of origin (COO) was determined using Hans’ algorithm. For the clonal relationship between tumor and discordant BM, the VDJH rearrangement was analyzed. Survival analyses were restricted to 189 patients treated with rituximab and chemotherapy. Thirty-six (16%) had concordant, and 37 (16%) discordant BM infiltration. FCM described different indolent lymphomas among discordant cases, clonally related with DLBCL in 10/13 available samples. Median follow-up was 58 months. 5-year-progression-free survival (PFS) for non-infiltrated, discordant and concordant groups was 68%, 65% and 30%, respectively (<i>p</i> < 0.001). Combining COO and BM infiltration, patients with discordant BM and non-germinal center B-cell COO also had decreased 5-year-PFS (41.9%). In multivariate analysis, concordant BM had an independent effect on PFS (HR 2.5, <i>p</i> = 0.01). Five-year cumulative incidence of central nervous system (CNS) relapse was 21%, 4% and 1% in concordant, discordant and non-infiltrated groups, respectively (<i>p</i> < 0.001). In conclusion, concordant BM infiltration represents a subset with poor prognosis, whereas the prognostic impact of discordant BM infiltration could be limited to non-CGB cases.https://www.mdpi.com/2072-6694/12/2/474bone marrow involvementdiffuse large b-cell lymphomadiscordant bone marrowconcordant bone marrowcns relapse |