Frequency of bone marrow involvement among older patients with non-hodgkin's lymphoma with primary lymph nodes involvement

Abstract

Introduction: Non-Hodgkin's lymphomas(NHL) are malignant tumors that develop from lymphoid tissue. They can affect various organs and tissues, however, the most common primary location is the peripheral lymph nodes(LN). Bone marrow(BM) examination is considered essential in the evaluation and staging of NHL at the time of initial diagnosis as well as after therapy. BM examination can provide significant diagnostic and prognostic information in patients with NHL. We aimed to determine the frequency of BM involvement among older patients with NHL with primary lymph nodes involvement. Methods: A retrospective study was conducted on 78 patients with NHL with primary LN involvement aged between 60 and 84 years, examining the primary site of involvement and the frequency of BM involvement. Results: It was found that NHL with onset in the LN had developed more frequently in people aged 60 to 70 years(73.1%). NHL more often developed primarily in the peripheral LN(84.7%), less frequently in the mediastinal LN(6.4%), and abdominal LN(8.9%). Aggressive NHL predominated(59.0%), indolent NHL were diagnosed in 41.0%, more frequently in cases of affection to the cervical LN(47.4%), inguinal LN(41.7%) and abdominal LN(42.9%). Using BM biopsy it was determined that the BM involvement occurred in 43,2% of the cases. It is necessary to emphasize that the bone marrow involvement occurred approximately with the same frequency among patients aged 60 to 70 and 71 to 80 years(42.3% and 44.4%, respectively). Bone marrow involvement occurred predominantly in indolent NHL(17 out of 32 patients followed up to stage IV - 53.1%). Unlike indolent NHL, in the aggressive variants, the bone marrow was interested only in 2 out of 46 patients later developed to stage IV - 4.3%. Bone marrow metastases occurred more frequently among patients with NHL onset in the abdominal, axillary, and cervical lymph nodes (66.7%, 66.7%, and 55.5%, respectively). In cases of primary involvement of the inguinal and supraclavicular lymph nodes, bone marrow involvement was found less frequently (28.6% and 16.7%, respectively). In patients with mediastinal NHL, bone marrow damage was not detected in any case. Conclusions: NHL with primary LN involvement developed more frequently among people aged 60 to 70 years. BM involvement was determined in 43,2%. BM involvement was diagnosed more frequently in indolent NHL 53,1% compared to the aggressive NHL - constituting 4,3%. The most common LN sites associated with BM involvement were axillary(66,7%) abdominal(66,7%) and cervical LN(55,5%). BM involvement in the case of NHL plays the role of a negative predictor, being associated with low chances to obtain CR.