Combination of Bone Marrow Biopsy and Flow Cytometric Analysis: The Prognostically Relevant Central Approach for Detecting Bone Marrow Invasion in Diffuse Large B-Cell Lymphoma
Haruya Okamoto,
Nobuhiko Uoshima,
Ayako Muramatsu,
Reiko Isa,
Takahiro Fujino,
Yayoi Matsumura-Kimoto,
Taku Tsukamoto,
Shinsuke Mizutani,
Yuji Shimura,
Tsutomu Kobayashi,
Eri Kawata,
Hitoji Uchiyama,
Junya Kuroda,
Kyoto Clinical Hematology Study Group Investigators
Affiliations
Haruya Okamoto
Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
Nobuhiko Uoshima
Department of Hematology, Japanese Red Cross Kyoto Daini Hospital, Kyoto 602-8031, Japan
Ayako Muramatsu
Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
Reiko Isa
Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
Takahiro Fujino
Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
Yayoi Matsumura-Kimoto
Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
Taku Tsukamoto
Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
Shinsuke Mizutani
Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
Yuji Shimura
Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
Tsutomu Kobayashi
Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
Eri Kawata
Department of Hematology, Matsushita Memorial Hospital, Osaka 570-8540, Japan
Hitoji Uchiyama
Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto 605-0981, Japan
Junya Kuroda
Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
Kyoto Clinical Hematology Study Group Investigators
Bone marrow (BM) involvement is associated with prognosis in diffuse large B-cell lymphoma (DLBCL), the most prevalent disease subtype of malignant lymphoma. We conducted this multi-institutional retrospective study to investigate the functional association and prognostic values of four BM tests (BM biopsy, BM clot, flow cytometry (FCM), and BM smear). A total of 221 DLBCL patients were enrolled. BM involvement was detected in 17 (7.7%), 16 (7.2%), 27 (12.2%), and 34 (15.4%) patients by BM biopsy, BM clot, FCM, and BM smear, respectively. The consistency between BM biopsy and clot examination was favorable, with a κ coefficient of 0.705, whereas the consistencies among other modalities were poor. In 184 patients treated with the first-line R-CHOP (-like) regimen, BM involvement was associated with shorter progression-free survival (PFS) irrespective of the type of modality for a positive result. Intriguingly, among various single and combinatory modalities, the combination of BM biopsy and FCM had the highest hazard ratio of 3.33 and a c-index of 0.712. In conclusion, our study suggested that the combination of BM biopsy and FCM is the prognostically relevant central approach for BM involvement detection. The other BM examinations also may provide complementary information in clinical settings.
