STUDY OF PREVALENCE AND PATTERN OF BONE MARROW INVOLVEMENT IN LYMPHOMAS -A TERTIARY CARE HOSPITAL STUDY IN KASHMIR.
BACKGROUND: BM infiltration by lymphoma places the patient in Stage IV disease and these patients manifest poor prognosis and response to treatment. In patients with bone marrow involvement by lymphomas, the marrow smears and trephine sections are collectively interpreted for cytology,pattern of bone marrow infiltration,and sometimes Immunophenotyping.Materials and methods: A 5 year (Jan 2013 to Dec17) study was conducted in the Deptt. of Pathology and Clinical Hematology, SKIMS.All the cases reported as NHL & HL were reviewed and analyzed.The data included bone marrow aspiration and bone marrow biopsy samples and relevant blocks and slides.In this study we tried to study prevalence and pattern of bone marrow involvement in NHL & HL. Results :NHL to HL ratio was (7:1). DLBCL was the most common (54.3%) subtype followed by FL(7.8%), SLL (6.8%).NHL pts. were in the age group of 41-60 yrs whereas HL were of 21-40 yrs. Male to female ratio is equal to 2:1.Infiltration was seen in 22.6% cases in BMB and in 18.3% cases in BMA.Infiltration was commonest in LPL (75% cases), f/b SLL 63%), FL (50%), ALCL (42.9%), MZL (37%), DLBCL(20.8%), BL (25%), MCL (16%) & HL (7%).Diffuse pattern of infiltration was most common followed by interstitial,mixed,paratrabecular and nodular .The reliability of BMB was significantly higher than that of BMA.Conclusion:We conclude that Bone marrow examination is an important investigation in cases of Lymphoma which has a prognostic and at times diagnostic relevance. The highest frequency of marrow disease was encountered in elderly patients with indolent lymphomas. The BMB had a higher diagnostic validity whereas; BMA served a good test in screening lymphomas positive for marrow disease. However, a negative BMA does not exclude marrow involvement.Pattern of infiltration showed significant variation in bone marrow involvement Immunohistochemistry increased the diagnostic accuracy.HL had a low rate of BM involvement.
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