Abstract
BackgroundMalignant bone lymphoma can be classified as primary (PBL) or secondary (SBL) bone lymphoma. However, the clinico-pathological characteristics and prognostic factors of PBL versus SBL have not yet been well defined. Whether lymphoma with multifocal bone involvement should be considered as stage IV PBL or SBL still remain controversial throughout the literature.MethodsIn this study, we retrospectively reviewed 127 patients with bone lymphoma diagnosed from1998 to 2013 at the Moffitt Cancer Center. Patients were classified as PBL (81 cases) and SBL (46 cases) using the 2013 WHO Classification of Bone/Soft Tissue Tumors and PBL patients were further subdivided into: 1) PBL with unifocal bone disease (uPBL, 46 cases), 2) PBL with multifocal bone involvement (mPBL, 35 cases). Patient characteristics, survival, and prognostic factors were analyzed.ResultsDiffuse large B-cell lymphoma (DLBCL) was the most common histological subtype in all three groups (37/46 of uPBL, 23/35 of mPBL, 23/46 of SBL). B symptoms, lymph node involvement, and bone marrow involvement were found to be more common in mPB-DLBCL and SB-DLBCL groups than in the uPB-DLBCL group. Femur was found to be the most common affected site in uPB-DLBCL patients, while spine was most commonly involved in the other two groups. Survival analysis indicated that uPBL-DLBCL patients had a significantly better progression-free survival (PFS) and overall survival (OS) than those in the other two groups (P < 0.05). We also found by univariate analysis that multifocality, and stage IV were significantly poor prognostic factors for both PFS and OS in PBL patients. Using multivariate analysis, multifocality remained an independent prognostic factor for both PFS and OS (P = 0.0117, RR: 3.789, 95% CI: 1.275-11.256).ConclusionOverall, our results suggest that mPBL is more similar to SBL in characteristics and survival rather than uPBL, and thus should be better classified and treated as SBL.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2407-14-900) contains supplementary material, which is available to authorized users.
Highlights
Malignant bone lymphoma can be classified as primary (PBL) or secondary (SBL) bone lymphoma
Classical Hodgkin lymphoma and follicular lymphoma were more commonly shown in secondary bone lymphoma (SBL) group, while only 1 classical Hodgkin lymphoma case was identified in the primary bone lymphoma (PBL) groups
Spine was most commonly involved in mPB-Diffuse large B-cell lymphoma (DLBCL) and SB-DLBCL. From this point of view, our results suggest that mPBL is more similar to clinical characteristics of patients with SBL rather than with primary bone lymphoma with unifocal bone disease (uPBL)
Summary
Malignant bone lymphoma can be classified as primary (PBL) or secondary (SBL) bone lymphoma. Whether lymphoma with multifocal bone involvement should be considered as stage IV PBL or SBL still remain controversial throughout the literature. According to the initial extent of disease, malignant bone lymphomas can be divided into two groups: primary bone lymphoma (PBL) and secondary bone lymphoma (SBL) [1,2]. SBL is more common, seen in approximately 16% to 20% of patients with lymphoma, and has a relatively poor prognosis [1]. Given their different clinical outcomes and treatment strategies, subclassification of bone lymphomas into either primary or secondary bone lymphomas is critical. The clinico-pathological characteristics and prognostic factors of PBL versus SBL have not yet been well studied
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