Publié sur : Journal of Clinical Oncology, vol 23, suppl. - 2005
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Long-term experience with primary non-Hodgkin's bone lymphoma
G.Delépine, F.Delépine, H.Cornille, B.Markowska, Nicole Delepine

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Long-term experience with primary non-Hodgkin's bone lymphoma

Leukemia, Lymphoma, Myeloma, and Transplantation (Adult) / Lymphoma

Abstract:

Background:
Primary bone lymphomas are rare diseases accounting for 3 % of primary tumors of bone and about 5% of all extranodal non-hodgkin's lymphomas. Inspite of a better prognosis than other lymphomas, there is no consensus about optimal treatment. We report on our experience .

Methods:
17 patients (p.) were identified, among more than 650 treated for bone malignant tumors by the team from 1985. We retrospectively reviewed all cases and medical record was examinated. Age at diagnosis, sex, NHL clinical staging, clinical symptoms, treatment and response were retrieved.

Results:
17 p. with newly diagnosed PLB were treated from dec. 1985 to Jan 2003. Eight patients were male and 9 female, median age was 37 years, range 19-75 .14 p. had a solitary lesion (stage 1) and 3 had tumor spread to locoregional lymphatic area (stage 2). Locations were femur (9), iliac bone(4), clavicule(2) sacral bone (2). All had B-cell grade histology. Local tumor was treated by : radiotherapy ( 11) en-bloc resection (4 ), both (2). With a median follow-up of 14 years, 14 p. are in EFS. Three p. died, one following a toxicity related to: high dose chemotherapy (1) secondary osteosarcoma related to radiotherapy -8 y post treatment -(1) vascular cerebral event (1). No progressive disease was seen. Complications from radiotherapy were important and frequent (3/13:24%):post radiotherapy osteosarcoma, epiphysis femur fracture, diaphysis femur fracture . The actuarial 10 y overall survival is 84% and actuarial event free survival years is 90 % for the entire group.

Conclusions:
PLB is a curable malignancy as confirmed by many authors, (ASCO 2004, n° 6587 in a large cohort). This evidence leads to avoid agressive methods to cure it, as high dose chemotherapy and may be, radiotherapy. Doctors must initially prove that the lymphoma of bone is truly a primary tumor and not a classic hematologic malignancy, and in this case, give a treatment combinating conventional chemotherapy and adapted surgery. The place of radiotherapy as local treatment should be reevaluated.

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