Annals of Oncology Advance Access originally published online on October 3, 2006
Annals of Oncology 2007 18(1):129-135; doi:10.1093/annonc/mdl329
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© 2006 European Society for Medical Oncology
hematologic malignancies |
A clinicopathological retrospective study of 131 patients with primary bone lymphoma: a population-based study of successively treated cohorts from the British Columbia Cancer Agency
1 Division of Hematology
2 Division of Medical Oncology
3 Division of Pathology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
* Correspondence to: Dr J. M. Connors, British Columbia Cancer Agency and the University of British Columbia, 600 West 10th Avenue, Vancouver, British Columbia V5Z 4E6, Canada. Tel: +1-604-877-6000 x 2746; Fax: +1-604-877-0585; E-mail: jconnors{at}bccancer.bc.ca
Background: Primary bone lymphoma (PBL) is a distinct clinicopathological entity. Although PBL has been reviewed in several small studies, few reflect recent improvements in primary treatment.
Methods: We used the British Columbia Cancer Agency Lymphoid Cancer Database to identify all patients with PBL (1983–2005). All were staged in a uniform manner and treated with era-specific protocols.
Results: We identified 131 patients with a median age of 63 years (18–87). One third had disease in long bones and another one third had disease in the spine, of which half presented with spinal cord compression. Patients with diffuse large-cell lymphoma (DLCL) (n = 103, 79%) had 5- and 10-year overall survivals (OS) of 62% and 41%, respectively. Multivariate analysis identified three prognostic groups: age <60 with International Prognostic Index (IPI) 1–3 (n = 43), age 
60 with IPI 0–3 (n = 23) and age 60 with IPI 4–5 (n = 33), with markedly different 5-year OS of 90%, 61% and 25%, respectively (P < 0.0001). Neither primary site nor pathological fracture at presentation had an impact on OS. The 3-year progression-free survival in patients who received rituximab plus combination chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOPR) chemotherapy was 88% compared with 52% in those who received CHOP-like chemotherapy without rituximab (P = 0.005). The 10-year OS for those with advanced-stage disease who received irradiation plus chemotherapy was 25% versus 56% for those who received chemotherapy alone (P = 0.025). Patients received irradiation if spinal cord compression was present or residual disease at the end of chemotherapy was thought to require it.
Conclusions: PBL is usually of DLCL type and has an improved outcome with CHOPR. Younger patients with good IPI score have a favorable prognosis.
Key words: bone, lymphoma, presentation, treatment
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