Combination of Bone Marrow Biopsy and Flow Cytometric Analysis: The Prognostically Relevant Central Approach for Detecting Bone Marrow Invasion in Diffuse Large B-Cell Lymphoma.

Kyoto Clinical Hematology Study Group Investigators ,Tsutomu Kobayashi,Ayako Muramatsu,Junya Kuroda,Yuji Shimura,Reiko Isa,Takahiro Fujino,Eri Kawata,Yayoi Matsumura-Kimoto,Hitoji Uchiyama,Nobuhiko Uoshima,Haruya Okamoto,Taku Tsukamoto,Shinsuke Mizutani

doi:10.3390/diagnostics11091724

Abstract

Bone marrow (BM) involvement is associated with prognosis in diffuse large B-cell lymphoma (DLBCL), the most prevalent disease subtype of malignant lymphoma. We conducted this multi-institutional retrospective study to investigate the functional association and prognostic values of four BM tests (BM biopsy, BM clot, flow cytometry (FCM), and BM smear). A total of 221 DLBCL patients were enrolled. BM involvement was detected in 17 (7.7%), 16 (7.2%), 27 (12.2%), and 34 (15.4%) patients by BM biopsy, BM clot, FCM, and BM smear, respectively. The consistency between BM biopsy and clot examination was favorable, with a κ coefficient of 0.705, whereas the consistencies among other modalities were poor. In 184 patients treated with the first-line R-CHOP (-like) regimen, BM involvement was associated with shorter progression-free survival (PFS) irrespective of the type of modality for a positive result. Intriguingly, among various single and combinatory modalities, the combination of BM biopsy and FCM had the highest hazard ratio of 3.33 and a c-index of 0.712. In conclusion, our study suggested that the combination of BM biopsy and FCM is the prognostically relevant central approach for BM involvement detection. The other BM examinations also may provide complementary information in clinical settings.

Highlights

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphomas (NHLs)
They were subjected to simultaneous Bone marrow (BM) tests via four diagnostic modalities: BM biopsy, clot examination (BM clot), microscopic examination (BM smear), and flow cytometry (FCM), between 2012 and 2018 at three independent institutes belonging to the Kyoto Clinical Hematology Study Group
Our result indicated that BM involvement detected by BM biopsy was significantly associated with performance status (PS), increased serum level of lactate dehydrogenase (LDH), and more advanced disease stage

Summary

Introduction

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphomas (NHLs) It accounts for approximately 30% of NHLs and is a clinically and molecularly heterogeneous disease entity [1,2,3]. To avoid inappropriate treatment for high-risk disease and overtreatment with excess toxicity for standard-risk disease, it is important to predict treatment success or failure with the current standard first-line treatment in patients with DLBCL. In this regard, various prognostic indices of clinical manifestations have been used in daily clinical practice [4,5,6,7]. Various molecular classifications have been proposed to understand disease pathophysiology and predict prognosis in DLBCL [1,2,3]

Objectives

Methods

Results

Conclusion