How useful is bone marrow study as an initial investigative tool without lymph node biopsy in malignant lymphoma?: Eleven years of experience at a single institution

Hemophagocytic lymphohistiocytosis as an onset of diffuse large B‑cell lymphoma: A case report

A 53-year-old male presented with a 1-month history of hyperpyrexia. The clinical manifestations revealed hemophagocytic lymphohistiocytosis (HLH). Although a lymph node biopsy could not be obtained, a bone marrow biopsy revealed the activated B-cell subtype of diffuse large B-cell lymphoma (DLBCL). After being treated with HLH-1994 (dexamethasone and etoposide), a rituximab-containing chemotherapy and target agents involving bortezomib, the patient achieved remission. To understand the molecular profile of patient, next-generation sequencing and MYD88 L265P mutation examinations were performed, and the patient was determined to be positive for the MYD88 L265P mutation. Reports of DLBCL with plasmacytic differentiation and a MYD88 innate immune signal transduction adaptor L265P mutation concurrent with HLH are rare. Early recognition, precise diagnosis and timely therapy are pivotal in improving patient prognosis. Furthermore, molecular profiling enables researchers to develop potential therapies aimed at the activated NF-κB and endoplasmic reticulum stress signaling pathways. The present study highlights this pathogenesis and provides suggestions for further individualized therapeutics.

Prediction Model of Bone Marrow Infiltration in Patients with Malignant Lymphoma Based on Logistic Regression and XGBoost Algorithm

Objective

The prediction model of bone marrow infiltration (BMI) in patients with malignant lymphoma (ML) was established based on the logistic regression and the XGBoost algorithm. The model's prediction efficiency was evaluated.

Methods

A total of 120 patients diagnosed with ML in the department of hematology from January 2018 to January 2021 were retrospectively selected. The training set (n = 84) and test set (n = 36) were randomly divided into 7 : 3, and logistic regression and XGBoost algorithm models were constructed using the training set data. Predictors of BMI were screened based on laboratory indicators, and the model's efficacy was evaluated using test set data.

Results

The prediction algorithm model's top three essential characteristics are the blood platelet count, soluble interleukin-2 receptor, and non-Hodgkin's lymphoma. The area under the curve of the logistic regression model for predicting the BMI of patients with ML was 0.843 (95% CI: 0.761~0.926). The area under the curve of the XGBoost model is 0.844 (95% CI: 0.765~0.937).

Conclusion

The prediction model constructed in this study based on logistic regression and XGBoost algorithm has a good prediction model. The results showed that blood platelet count and soluble interleukin-2 receptor were good predictors of BMI in ML patients.

The Profile of MicroRNA Expression in Bone Marrow in Non-Hodgkin’s Lymphomas

Non-Hodgkin’s lymphomas (NHLs) are a heterogeneous group of malignant lymphomas that can occur in both lymph nodes and extranodal sites. Bone marrow (BM) is the most common site of extranodal involvement in NHL. The objective of this study is to determine the unique profile of miRNA expression in BM affected by NHL, with the possibility of a differential diagnosis of NHL from reactive BM changes and acute leukemia (AL). A total of 180 cytological samples were obtained by sternal puncture and aspiration biopsy of BM from the posterior iliac spine. All the cases were patients before treatment initiation. The study groups were NHL cases (n = 59) and AL cases (acute lymphoblastic leukemia (n = 25) and acute myeloid leukemia (n = 49)); the control group consisted of patients with non-cancerous blood diseases (NCBDs) (n = 48). We demonstrated that expression levels of miRNA-124, miRNA-221, and miRNA-15a are statistically significantly downregulated, while the expression level of let-7a is statistically significantly upregulated more than 2-fold in BM in NHL compared to those in AL and NCBD. ROC analysis revealed that let-7a/miRNA-124 is a highly sensitive and specific biomarker for a differential diagnosis of BM changes in NHL from those in AL and NCBD. Therefore, we conclude that analysis of miRNA expression levels may be a promising tool for early diagnosis of NHL.

How useful is bone marrow study as an initial investigative tool without lymph node biopsy in malignant lymphoma?: Eleven years of experience at a single institution

BACKGROUND

Bone marrow (BM) study plays an important role as initial investigation specimen of lymphoma as well as staging lymphoma. This study aimed to investigate the utility of BM studies for classification of lymphoma and evaluate features of BM involvement by lymphoma over a period of 11 years.

METHODS

A total of 1162 cases of BM studies for lymphoma evaluation were reviewed for the incidence of lymphoma subtypes, the percentage of marrow involvement, the pattern of involvement and discordance with histopathologic diagnoses of lymph nodes and other tissues.

RESULTS

A total of 255 of 1162 cases underwent BM study without pathologic information, and 108 cases show lymphoma involvement. Lymph node biopsy underwent in 66 cases, and 10 cases show discordant result between BM and lymph node biopsy. Seven discordant cases were due to insufficient further studies. Lymphoma was diagnosed only by BM study in 38 cases. Abnormal lymphocytes were found in BM aspiration in 34 cases. Also, abnormal clonal lymphocytes were detected by flow cytometry in 26 cases. Four cases showed disease-related chromosomal abnormalities. FISH analysis detected abnormal findings in two cases, however, discordant with other additional studies.

CONCLUSIONS

Discrepancies between the BM study and lymph node biopsy were due to insufficient further study and discordance of immunohistochemical stain result. BM study can be utilized as initial diagnosis of lymphoma by the combination of morphological feature, involvement pattern, and additional tests such as flow cytometry, chromosomal analysis, and FISH analysis. Thus, BM study with further analysis is an essential choice when lymph node biopsies are unavailable.