Is Bone Marrow Biopsy Necessary for Patients with Primary Central Nervous System Large B-Cell Lymphoma?
Christine S Lin, Manette Monroe, David D Grier, Ryan T Mott, Erin M Dunbar, Ying Li, Anthony T Yachnis, Samer Z Al-Quran. University of Florida, Gainesville; Wake Forest University Baptist Medical Center, Winston-Salem, NC
Background: Primary central nervous system large B-cell lymphoma (PLBCL) comprises approximately 4% of primary intracranial malignancies. Men and women are affected equally with a median age of onset occurring in the sixth decade. Symptoms vary, with neurological deficits and neuropsychiatric symptoms being the most prevalent. Most PLBCL belong to the non-germinal center subtype and are associated with a poor prognosis. Once the diagnosis is confirmed, staging with imaging studies, HIV testing, bone marrow biopsy (BMB) and lumbar puncture are recommended. BMB is a painful, invasive and expensive procedure. The majority of studies published demonstrate no evidence of systemic involvement in patients with PLBCL. The aim of our study is to assess the utility of BMB in these patients and its effect on therapeutic decisions.
Design: A retrospective review of all biopsy-proven PLBCLs, diagnosed between 1999 and 2010 at two academic medical centers, was performed. None of the patients had lymph node or other organ involvement at the time of diagnosis. Patients with HIV were excluded due to a greater likelihood of disseminated disease at presentation. Biopsy sections, immunohistochemical studies and flow cytometry data were reviewed, when available. The time interval between diagnosis and BMB, treatment regimen and outcome were recorded for each patient.
Results: Ninety-three patients diagnosed with PLBCL were identified. Forty-one patients (44%) had BMBs as part of staging or for inclusion into a clinical trial. The average time interval from initial diagnosis to BMB was 21 days. Only four patients (4.3%) had concurrent bone marrow involvement. However, bone marrow involvement did not alter disease outcome or treatment regimen in these patients.
Conclusions: The results of this retrospective review suggest the routine use of BMBs in PLBCL staging may be of limited value. Treatment is usually withheld until the results of the BMB are complete. Given the malignant nature of the disease, a delay in treatment can detrimentally impact prognosis. Furthermore, BMB is associated with significant patient discomfort and expense. The utility and cost-effectiveness of BMB in patients with PLBCL should be further evaluated in larger evidence-based studies.
Tuesday, March 1, 2011 1:00 PM
Poster Session IV # 163, Tuesday Afternoon