Abstract:
:In diffuse large B-cell lymphoma (DLBCL), the clinical and biological significance of concordant and discordant bone marrow (BM) involvement have not been well investigated. We evaluated 712 de novo DLBCL patients with front-line rituximab-containing treatment, including 263 patients with positive and 449 with negative BM status. Compared with negative BM disease, concordant BM adversely impacted overall and progression-free survival, independent of the International Prognostic Index (IPI) and cell-of-origin classification. Once BM is concordantly involved, poor prognosis was not associated with the extent of BM involvement. Conversely, patients with discordant BM showed favorable overall survival similar to stage I-II DLBCL. A BM-adjusted IPI, using three parameters: concordant BM involvement, age >60 years, and performance status >1, improves the risk stratification for DLBCL with positive BM. Intensive immunochemotherapy seemingly rendered survival benefit for patients with concordant BM, as did rituximab maintenance for the discordant BM group. Frequently revealing adverse clinical and molecular characteristics, patients with concordant BM demonstrated gene expression signatures relevant to tumor cell proliferation, migration and immune escape. In conclusion, clinical and biological heterogeneity is seen in DLBCL with positive BM but concordant BM involvement represents a distinct subset with unfavorable gene signatures, high-risk clinicopathologic features and poor prognosis.
journal_name
Leukemiajournal_title
Leukemiaauthors
Yao Z,Deng L,Xu-Monette ZY,Manyam GC,Jain P,Tzankov A,Visco C,Bhagat G,Wang J,Dybkaer K,Tam W,Hsi ED,van Krieken JH,Ponzoni M,Ferreri AJM,Møller MB,Winter JN,Piris MA,Fayad L,Liu Y,Song Y,Orlowski RZ,Kantarjiadoi
10.1038/leu.2017.222subject
Has Abstractpub_date
2018-02-01 00:00:00pages
353-363issue
2eissn
0887-6924issn
1476-5551pii
leu2017222journal_volume
32pub_type
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