Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma, accounting for about 1/3rd cases of NHL. At diagnosis, DLBCL involves the bone marrow in approximately 15-25% of cases. However, the bone marrow may reveal discordant morphology from the lymph node, usually an indolent lymphoma.

Bone marrow biopsy is routinely used in the staging evaluation of patients with DLBCL. The aim of this study was to determine if clinical variables could predict bone marrow involvement by DLBCL.

Methods

Retrospective chart review of all patients with a diagnosis of DLBCL at University of Missouri-Columbia/Ellis Fischel Cancer Center from 1993-2013. The following parameters were reviewed: bone marrow biopsy reports, anemia (Hb<10g/dl), leukopenia (wbc<4000), thrombocytopenia (<150,000), lactate dehydrogenase level and clinical stage. Statistical analysis was performed by Fischer Exact test and logistic regression analysis.

Results

80 charts were available for review and 7 patients had bone marrow involvement by DLBCL. Univariate analysis for cytopenias (p=0.459), elevated LDH (p=0.442), anemia (p=0.436), leukopenia (p=1.0) and thrombocytopenia (p=0.434) and bone marrow involvement by DLBCL showed no statistical significance (Fischer Exact test). Multivariate analysis comparing anemia, leukopenia, thrombocytopenia, elevated LDH and clinical stage with respect to bone marrow involvement revealed p=0.789, p=0.134, p=0.062, p=0.827 and p=0.521 respectively, and disclosed no statistical significance (logistic regression analysis). Univariate (Fisher exact tests and Cochran-Mantel-Haenszel statistics) and multivariate (logistic regression) analyses were used to test for the relationship of these parameters with bone marrow involvement.

Table 1

Univariate and multivariate analysis of the relationship of parameters to bone marrow involvement in 80 DLBCL patients

ParameterUnivariate p valueOdds ratio (95% CI)Multivariate p value
Anemia .44 1.07 (0.08-16.4) .79 
Leukopenia >.99 0.17 (0-2.68) .13 
Thrombocytopenia .43 7.04 (0.37-Infinity) .06 
Elevated LDH .44 0.77 (0.06-6.49) .83 
Clinical Stage .21  .52 
I vs IV  2.99 (0.17-200.00)  
II vs IV  1.60 (0.21-Infinity)  
III vs IV  1.04 (0.09-17.86)  
ParameterUnivariate p valueOdds ratio (95% CI)Multivariate p value
Anemia .44 1.07 (0.08-16.4) .79 
Leukopenia >.99 0.17 (0-2.68) .13 
Thrombocytopenia .43 7.04 (0.37-Infinity) .06 
Elevated LDH .44 0.77 (0.06-6.49) .83 
Clinical Stage .21  .52 
I vs IV  2.99 (0.17-200.00)  
II vs IV  1.60 (0.21-Infinity)  
III vs IV  1.04 (0.09-17.86)  
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Disclosures:

No relevant conflicts of interest to declare.

Topics:
bone marrow involvement, diffuse large b-cell lymphoma, anemia, leukopenia, thrombocytopenia, bone marrow biopsy, cytopenia, lactate dehydrogenase measurement, lymphoma, non-hodgkin, non-hodgkin's lymphoma, indolent

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2013 by The American Society of Hematology
2013
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