Morphologic Dysplasia in Staging Marrow from High-Grade Non-Hodgkin's Lymphoma Patients: A Paraneoplastic Phenomenon Associated with Adverse Clinical Outcome
V Nardi, JS Abramson, RP Hasserjian. Massachusetts General Hospital, Boston, MA
Background: Morphologic dysplasia has rarely been reported in the bone marrow of patients with solid tumors, including non-Hodgkin's lymphomas (NHL). The significance of this finding and its relationship to patient outcome are unknown. We conducted a retrospective evaluation of staging bone marrow samples from patients with high-grade NHL with and without morphologic dysplasia.
Design: The cases (NHL-D) comprised 16 patients with high-grade NHL (11 DLBCL, 2 Burkitt, 2 Grade 3 FL, 1 ALK+ ALCL) with morphologic dysplasia in any hematopoietic lineage in the pre-treatment staging bone marrow. The control group (NHL-C) included 14 patients with high-grade NHL (13 DLBCL, 1 Grade 3 FL) lacking morphologic dysplasia. Patients with marrow involvement by NHL, history of cytotoxic therapy or any known cause of cytopenia were excluded. Chemotherapeutic regimens were similar in the two groups. Hematologic and clinical features were determined at diagnosis and after chemotherapy.
Results: In the NHL-D group, dysplasia involved the erythroid lineage in 13/16 cases, the myeloid lineage in 3/16 cases, and the megakaryocytic lineage in 1/16 cases. There was no statistical difference between gender, age, stage of disease, or presence of B symptoms between the NHL-D and NHL-C groups. Comparison of clinical parameters between the two groups is summarized in Table 1. The NHL-D patients were borderline more likely to be treated with G-CSF and/or transfusions (p=0.07), had longer hemoglobin recovery after completing chemotherapy (median 120 versus 16 days) and had significantly inferior relapse-free survival (p=0.02, log rank test) compared to the NHL-C group, in spite of similar lymphoma types and therapies. 1 patient with the NHL-D group and 0 patients in the NHL-C group developed therapy-related AML/MDS.
|Finding||NHL-D (n=16)||NHL-C (n=16)||p-value|
|Hemoglobin (mean, g/dL)||12.3||14.0||0.004|
|WBC (mean, x109/L)||6.6||8.0||NS|
|Platelets (mean, x109/L)||249||267||NS|