Primary bone lymphoma – the University of Miami experience

Abstract

Primary bone lymphoma (PBL) is a rare disease. There has been paucity of studies addressing its therapy and prognosis. We retrospectively examined PBL cases seen at the University of Miami from June 2000 to August 2007 to describe our single institution experience and review the literature. Fifty-three patients were identified with a median age of 52 (18-87) and a median follow-up of 40 months (0-106). The most common histologic type was diffuse large B-cell lymphoma (83%). Forty-one patients (77%) presented with localized disease and 48 were treated at our institution. Forty-six patients underwent chemotherapy (40 patients) and/or radiation (36 patients). Forty-four patients achieved a complete response and all patients were alive at last follow-up. The progression-free survival (PFS) was 83% at 4 years. No difference in PFS was observed between patients treated with chemotherapy or combined chemotherapy plus radiation. There was a trend toward improvement in PFS (p = 0.062) of patients with DLBCL treated with rituximab plus chemotherapy. Our single institutional experience demonstrates that the outcome of patients with PBL is excellent. Although the current data support the use of combined modality treatment for localized PBL, randomized controlled trials are needed especially now, when rituximab is routinely added to chemotherapy regimens.

Primary sternum diffuse large B-cell lymphoma: A case report and review of the literature

“…Considering current studies and several previously-published studies, patients treated with chemoradiotherapy appeared to present an improved outcome compared with patients receiving single modality therapy (25)(26)(27)(28)(29). These observations require confirmation by prospective studies with larger sample groups, since specific studies appear to disprove them (2,26,27,33,34). For instance, in the IELSG-14 study, the addition of radiotherapy following chemotherapy, or the use of larger radiation fields and doses, were not associated with an improved outcome in patients treated with chemoradiotherapy (9).…”

“…Although previous studies have obtained contradicting results, chemoradiotherapy is likely to be superior to single modality therapy, which may be advantageous for localized unifocal bulky sites of disease, which allows a shorter chemotherapy course (1,30,35), or for multifocal disease in relapsing cases (36). Anthracycline-containing chemotherapy has become the standard therapy of DLBCL, while numerous studies have demonstrated increased long term remission rates with the incorporation of rituximab (33,(37)(38)(39)(40)(41)(42). Based on the aforementioned findings, chemotherapy plus rituximab (immunochemotherapy) is currently considered to be the first-line treatment for CD20-positive DLBCLs.…”

Primary lymphoma of bone: outcome and role of surgery

“…Persisting radiological abnormalities after treatment is a common finding in bone lymphomas and it does not prevent assessment of a remission state, which is evaluated upon the disappearance of local and systemic signs of lymphoma [5,11]. One patient achieved partial remission.…”

“…Ann Arbor stage I and stage II disease [3]; a lymphoma with the above-mentioned pattern can be considered a primary lymphoma of bone, as well as when involvement of bone marrow is present at diagnosis, i.e. Ann Arbor stage IV [4,5]. Due to the rarity of the disease, few series are reported in the literature, and only retrospective multicentre reviews involve high numbers of patients [6][7][8].…”

“…Little is reported about surgical procedures, even if surgery does, in some cases, become necessary for fractures or impending fractures. An incidence of orthopaedic surgical procedures other than biopsy, ranging from 13.8 % to 26 % [7][8][9][10] or even 47 % [5], is reported, but most papers either do not mention incidence or type of surgery [4,6,[11][12][13][14][15] or report incomplete data about the surgery performed [16,17]. Therefore, we decided to review our series in a single-centre, consecutive series of patients affected by primary bone lymphoma with the aim of: (1) evaluating incidence of surgery , (2) examining type of surgery and its combination with adjuvant treatment and (3) evaluating whether surgery should precede or follow radiotherapy and chemotherapy treatment.…”