Clinico-hematologic Findings of Leukemic Bone Marrow Involvement in Korean Patients with Non-Hodgkin Lymphoma

Ji-Myung Kim; Chan-Jeoung Park; Sung-Soo Jang; Hyun-Sook Chi; Joo-Ryung Huh; Yoon-Koo Kang; Jong-Jin Seo

doi:10.3343/lmo.2011.1.2.3

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Kim, Park, Jang, Chi, Huh, Kang, and Seo: Clinico-hematologic Findings of Leukemic Bone Marrow Involvement in Korean Patients with Non-Hodgkin Lymphoma

Original Article

Diagnostic Hematology

Laboratory Medicine Online

Laboratory Medicine Online 2011; 1(2): 81-87.

Published online: 1 April 2011

DOI: https://doi.org/10.3343/lmo.2011.1.2.3

Clinico-hematologic Findings of Leukemic Bone Marrow Involvement in Korean Patients with Non-Hodgkin Lymphoma

Ji-Myung Kim¹, Chan-Jeoung Park², Sung-Soo Jang², Hyun-Sook Chi², Joo-Ryung Huh³, Yoon-Koo Kang⁴, Jong-Jin Seo⁵

¹Department of Laboratory Medicine, Chungnam National University Hospital, Daejeon, Korea.

²Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.

³Department of Pathology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.

⁴Department of Oncology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.

⁵Department of Pediatrics, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.

Corresponding author: Chan-Jeoung Park. Department of Laboratory Medicine, Asan Medical Center, College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-4508, Fax: +82-2-478-0884, cjpark@amc.seoul.kr

Received 1 September 2010 Revised 9 February 2011 Accepted 11 February 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The purpose of the present study was to investigate the clinico-hematological findings of bone marrow (BM) involvement and leukemic phase in Korean patients with non-Hodgkin lymphoma (NHL).

Methods

We included 791 patients with NHL that were classified with the WHO (2008) criteria. Laboratory data, bone marrow histomorphologic features and medical records were reviewed. Leukemic phase was defined as when the proportion of neoplastic lymphoid cells comprised more than 10% of leukocytes in the peripheral blood or more than 25% of nucleated cells in the BM.

Results

We found that 21.7% (172/791) of the patients had BM involvement, and 6.2% (49/791) developed leukemic phase of the disease. NHL subtypes showing high frequencies of leukemic phase development were mantle cell lymphoma (40%), angioimmunoblastic T cell lymphoma (40%), lymphoblastic lymphoma (36.4%), and Burkitt lymphoma (26.1%). Compared to B-cell type, T-cell type of NHL showed significantly higher frequencies of BM involvement (18.6% vs 30.9%; P=0.0004) and leukemic phase development (4.8% vs 10.3%, P=0.008). Complete remission rate was significantly lower in leukemic (55.6%) than in non-leukemic (85.9%) group of patients (P=0.0002), whereas relapse rate was not different between the two groups. Death rate was higher in leukemic (46.9%) than in non-leukemic (30.1%) group of patients, and the 5-yr overall survival probability was significantly lower in leukemic group (P=0.02).

Conclusions

The incidence of leukemic phase development in NHL was lower in Korean patients than that reported for Western populations and higher in T-cell lymphoma. We confirmed that the presence of leukemic phase in NHL patients is associated with a poor prognosis.

Keywords: Leukemic phase, Non-Hodgkin lymphoma, Korean, WHO classification

Figures and Tables

Fig. 1

Overall survival in non-Hodgkin lymphoma patients with marrow involvement according to the presence or absence of leukemic phase.

Table 1

Incidence of bone marrow involvement and leukemic phase in 791 patients with WHO (2008) classified non-Hodgkin lymphoma

^*P value were determined using chi-square test, which represent the difference in frequencies of marrow involvement and leukemic phase between B-cell and T-cell lineage.

Abbreviations: DLBCL, diffuse large B cell lymphoma; MALT, mucosa-associated lymphoid tissue; SLL, small lymphocytic lymphoma; NMZL, nodal marginal zone B-cell lymphoma; PTL, peripheral T cell lymphoma; ALCL, anaplastic large cell lymphoma; AILT, angioimmunoblastic T cell lymphoma; S, syndrome.

Table 2

Lymphoma subtypes and detection time of leukemic phase in 49 patients showing leukemic phase of non-Hodgkin lymphoma

Abbreviations: See Table 1.

Table 3

Comparison of clinicohematological findings between leukemic and non-leukemic groups in 172 non-Hodgkin lymphoma patients with bone marrow involvement

^*Mean±SD; ^†Median (range).

Abbreviations: PB, peripheral blood; BM, bone marrow.

Table 4

Comparison of therapeutic response and clinical outcome between leukemic and non-leukemic groups of bone marrow involvement in 5 WHO subtypes of non-Hodgkin lymphoma

Abbreviation: CR, complete remission.

Notes

This article is available from http://www.labmedonline.org

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