Bone Marrow Involvement in Lymphoma: Study from Northern Thailand

Abstract

Background: Lymphomas have a pattern preference in bone marrow involvement (BMI) that helps in diagnosis, however, studies on the pattern of BMI show different results across the regions. Objective: To determine the prevalence of lymphomas with and without BMI, and evaluate the percentage, the patterns, and the discordance in cases with marrow involvement. Materials and Methods: Data from 1,083 newly diagnosed lymphoma patients in Maharaj Nakorn Chiang Mai Hospital between January 2013 and December 2020 were evaluated for BMI. The 267 patients with BMI were analyzed for prevalence. The available slides from 260 patients were assessed for percentage, patterns, and discordance. Results: The prevalence of BMI in non-Hodgkin lymphoma (NHL) was 255/1,014 (25.1%), with B-cell NHL it was 239/902 (26.5%), and T-cell NHL was 16/112 (14.3%), while the prevalence of BMI in Hodgkin lymphoma (HL) was 12/69 (17.4%). The prevalence of BMI was highest in patients with lymphoplasmacytic lymphoma (LPL) at 92.3%, followed by Burkitt lymphoma (BL) at 75.0%, and mantle cell lymphoma at 73.3%. The most common pattern was interstitial. A diffuse pattern was most common in BL and diffuse large B-cell lymphoma (DLBCL). A mixed pattern was most common in LPL. A paratrabecular pattern was most common in follicular lymphoma. HL usually had a pattern of Reed-Sternberg cells with a characteristic background. The discordant DLBCL was 12.4% (15/121) cases and patients with discordant DLBCL tended to have a superior overall survival. Conclusion: Each subtype of lymphoma has a different tendency to involve bone marrow and have a preference in patterns of involvement. These can provide a differential diagnosis of the subtypes of lymphoma. The discordant lymphoma is likely to have a better prognosis than the concordant one. This might affect the future treatment.