Primary bone lymphoma: Treatment results and prognostic factors with long‐term follow‐up of 82 patients

Abstract

Objective We sought to develop a list of 5 tests, treatments, or services commonly used in rheumatology practice whose necessity or value should be questioned and discussed by physicians and patients. Methods We used a multistage process combining consensus methodology and literature reviews to arrive at the American College of Rheumatology's (ACR) Top 5 list. Rheumatologists from diverse practice settings generated items using the Delphi method. Items with high content agreement and perceived high prevalence advanced to a survey of ACR members, who comprise >90% of the US rheumatology workforce. To increase the response rate, a nested random sample of 390 rheumatologists received more intensive survey followup. The samples were combined and weighting procedures were applied to ensure generalizability. Items with high ratings underwent literature review. Final items were then selected and formulated by the task force. Results One hundred five unique items were proposed and narrowed down to 22 items during the Delphi rounds. A total of 1,052 rheumatologists (17% of those contacted) participated in the member‐wide survey, whereas 33% of those in the nested random sample participated; respondent characteristics were similar in both samples. Based on survey results and available scientific evidence, 5 items (relating to antinuclear antibodies, Lyme disease, magnetic resonance imaging, bone absorptiometry, and biologic therapy for rheumatoid arthritis) were selected for inclusion. Conclusion The ACR Top 5 list is intended to promote discussions between physicians and patients about health care practices in rheumatology whose use should be questioned and to assist rheumatologists in providing high‐value care.

Primary lymphoma of bone: outcome and role of surgery

“…Other authors report a similar prevalence, with DLBCL accounting for 73 % to >90 % [4-6, 12, 13, 16, 17]. Pathological fractures are reported in 10-21 % of patients [4,5,12,16], but a rate of 43 % was found in one series [9]. In our series, 28.6 % of patients suffered a pathological fracture.…”

“…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.…”

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

“…For instance, Beal et al reported that the femur (27%), pelvis (15%) and tibia/fibula (13%) are the three commonly-affected locations (10). A case with initial involvement of the sternum was described in the present study, which is an uncommon phenotype in PBL.…”

“…PBL commonly affects male individuals with an age range between mid-40 and mid-60 years. The most common presentations are pain, swelling and PFs, while systemic symptoms, including fever, night sweats and weight loss, occur less frequently in PBL compared with other non-Hodgkin lymphomas (NHLs) (10). The majority of patients in previous studies presented with localized disease (19-21); however, with the improvements in imaging techniques, including CT, MRI, ECT and 18 F-fluorodeoxyglucose-positron emission tomography (PET)/CT, the incidence of multifocal disease has increased (22).…”

“…Diffuse large B-cell lymphoma (DLBCL) is the most common histological type of PBL, and the majority of patients have limited-stage disease (stages IE-IIE) at presentation (4,(6)(7)(8)(9). The most common symptoms at presentation are pain, swelling and pathologic fractures (PFs), however, systemic symptoms, such as fever, night sweats and weight loss, occur less frequently in PBL when compared with other NHLs (10). Previous studies have reported the use of radiotherapy, chemotherapy or a combination of the two for the treatment of PBL, resulting in a generally good prognosis.…”