The use of bone marrow (BM) biopsies may be unnecessary for the diagnostic workup of central nervous system (CNS) lymphomas with diffuse large B-cell lymphoma (DLBCL) histology if the patient’s positron emission tomography-computed tomography (PET-CT) scan is negative for lymphoma outside of the CNS, according to a Danish study published in the Annals of Hematology.
No instances of concordant lymphoma in the BM were found in the health records of 300 patients identified from the Danish Pathology Registry with CNS lymphomas with DLBCL histology and negative PET-CT scans for lymphoma outside of the CNS. Of the 300 patients, 252 were identified as having primary CNS lymphoma (PCNSL), while the other 48 had isolated CNS relapse of systemic lymphoma.
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“This study aims to improve diagnostic workup in patients with CNS lymphoma, spare patients from unnecessary painful [BM biopsies], and ensure optimal use of healthcare resources,” the authors wrote.
Various discordant pathological findings were observed in the BM biopsies of 25 patients and included other forms of lymphoma, leukemia, and myeloma, but none were DLBCL. The patients with discordant findings also tended to be older than those with CNS-isolated lymphoma (74.0 years vs 67.0 years).
No differences in sex were observed between the 2 groups, however, and the discordant findings did not ultimately affect the treatment approach for the patients.
“We did not find any patients with DLBCL involvement in the bone marrow. Consequently, we suggest that BM biopsy can be safely omitted from the diagnostic workup in patients with presumed PCNSL and negative PET scans,” the authors concluded.
No significant difference in age was observed between the patients with PCNSL and those with relapse of systemic lymphoma (68 years vs 65.5 years; P =.12). A majority of the patients were male (60%) and had supratentorial involvement (82.7%).
Corticosteroids were administered in 254 of the 289 patients with information about steroid usage in the registry. No significant difference was observed in steroid usage between patients with PCNSL and those with systemic lymphoma relapse isolated to the CNS (89.3% vs 80.4%; P =.091).
Jelicic J, Hansen DL, Carlsen SS, et al. Bone marrow biopsy can be omitted in the diagnostic workup of CNS lymphoma of DLBCL origin: a population-based retrospective study in the PET-CT era. Ann Hematol. Published online May 29, 2023. doi:10.1007/s00277-023-05282-7