Bone Involvement in Lymphoma: 36 Cases. An Argentinian Cooperative Study.

Bone involvement in linfomas is not very frequent, usually reflects progression of the disease and bad prognosis. The WHO recognizes 4 groups of lymphomas involving bone: 1) single primary bone site, 2) multiple bone sites, without visceral involvement, 3) bone lesion with visceral or lymph node involvement, 4) soft tissue lymphoma with bone involvement. Primary bone lymphoma (PBL) constitutes 3-7% of malignant bone tumors and 2-3% of extranodal lymphomas, groups 1 and 2 belong to this type. They are characterized by lytic lesions, predominant in metadiaphysis, with aggressive periosteal reaction and presence of soft tissue mass. The secondary affectation of bone has been described in 15 to 25 % of the linfomas in progression. Radiological studies, Scintigraphy, CT, MRI and PET allow to delimit extension.

To make a retrospective study of the clinical aspects, treatment and evolution of patients with lymphoma and bone involvement.

In a database from hemato-oncological patientes, 36 patients were studied: 30 Non Hodgkin Lymphoma (NHL):83, 33 % and 6 Hodgkin's Lymphoma (HL): 16, 66 % .

Bone involment was found in 32 cases at diagnosis and 4 in relapse.

B Lineage: 28 cases, T: 2. High grade 22 cases: 18 large cells B, 2 large cells T, 2 plasmoblastic; low grade: 7 small lymphocytic, 1 lymphoplasmocytic. Bone locations were multiple in 26 cases and localized in 10: 3 femur, 2 humerus, 1 tibia, 4 vertebral column (4 dorsal vertebrae, 1 lumbar).

Mean age: 49, 44 (20-86) years. Gender: M/F: 16/14. Stages: I: 26, 6 %, II: 16, 66 %, III: 10 %, IV: 46, 66 %. B symptoms in 25 %. Bone marrow involvement: 13, 88 %.

Symptoms: pain 40 %, pain and tumor in 13, 33 %, pain and lymph nodes: 16, 66%, tumor

(soft tissue involvement): 33,33%, pathological fracture: 10 %, paraplegia: 6,66%.

HIV positive 5 cases, (3 large cells B, 2 plasmoblastic), 2 maxilla, 2 mandible, 1 humerus.

Treatment: Chemotherapy (CT) in 28 patients), CHOP in 14, CVP 4, R-CHOP 3, EPOCH 2, ESHAP 2, CNOP, CAVPE, Fludara/CFM 1. 16 patients CT and Radiotherapy (RT), and 2 only RT. Evolution: 17 in complete response (RC), 6 dead, 6 without follow-up, 1 in treatment. Follow-up: 3-133 months, average: 44, 22.

4 nodular sclerosis, 2 mixed cellularity. Mean age: 31, 33 (21-37) years, stage IV in all; 3 bone involvement at diagnosis and 3 at relapse. Treatment: CT: ABVD: 4, BEACOPP 1, ESHAP 1.RT in 4. Autologous bone marrow transplant: 1.Evolution: 2 in RC, 2 dead, 2 in relapse, 1 in treatment.

Our population shares the criteria described in other series: LNH's predominance, aggressive histologies, predominant symptoms: pain and local tumor, with involvement of soft tissues. Adverse prognostic factors were stage IV and location in maxilla (33, 33% dead). Combined treatment: CT and RT allowed better results. With an average follow- up of 44,22 months, 17 patients with LNH remain in RC, stage I: 87,5 % RC. Patients HIV positive had a bad prognosis, CR only 1, follow up 26 months. Bone involvement in HL was associated with advanced disease (stage IV) and bad prognosis, 33, 3 % RC, follow up: 4-72 months, average: 35, 5.

No relevant conflicts of interest to declare.