Primary Lymphoma of Bone: A Clinico-Pathological Review and Analysis of Prognostic Factors

Primary non-Hodgkin’s bone lymphoma (PBL) is an uncommon malignancy first described by Oberling in 1928 [1], and established as a different clinical entity in 1939 [2]. It represents 7% of all bone tumors and less than 5% of non-Hodgkin’s extranodal lymphomas [3]. A retrospective review was performed with all consecutive patients with PBL diagnosed and treated at our center between January 1975 and December 2000. All patients had histological confirmation of non-Hodgkin’s lymphoma and were classified according to the Working Formulation. Tumor burden was evaluated with the M.D. Anderson criteria. Staging was based on the Ann Arbor classification. Assessment of response was performed according to the WHO criteria. Survival curves were estimated with the Kaplan –Meier method, and compared by means of the log-rank test. The Cox’s proportional hazard model was used to identify independent prognostic factors of survival. Age, stage, extranodal involved areas, performance status, and serum LDH levels, included in the International Prognostic Index (IPI) [4] were analyzed together. Patient characteristics are shown in Table I. All patients received treatment for PBL with either chemotherapy (1 patient, 5%), radiotherapy (3 patients, 14%), or combined chemotherapy+radiotherapy (17 cases, 81%). Chemotherapy schedules included anthracyclines in 83% cases. The most frequent employed of them was CHOP. The median dose of radiotherapy delivered was 40 Gy, with a boost of 500 cGy on primary lesions. Patients with PBL treated with chemotherapy received a median of 6 cycles (range, 1 – 12). Sixteen patients achieved a complete response (76%), 1 showed a disease stabilization (5%), and 4 patients progressed (19%). Six patients had a recurrence of the disease (29%), 2 of them primarily treated with radiotherapy alone, 1 case treated with chemotherapy alone, and 3 patients treated with combined modality. At the time of data analysis, with a median follow-up of 87 months (range, 7 – 297), 12 patients (57%) are alive and disease-free, while 9 have died, in 6 cases due to progression of non-Hodgkin’s lymphoma (29%) and in 3 due to other causes (radiation-induced osteosarcoma,

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