悪性リンパ腫の治療に関する研究 第2編 悪性リンパ腫治療における骨髄生検の意義

One hundred and thirty-one patients with malignant lymphoma, including 84 patients without prior therapy, underwent Jamshidi needle bone marrow biopsy and bone marrow aspiration simultaneously. At the time of diagnosis, 20 (28%) of 71 patients with non-Hodgkin's lymphoma had bone marrow involvement, and the incidence of bone marrow involvement was higher in the diffuse medium-sized cell subtype than in the diffuse large cell subtype (42% vs. 13%, p<0.05). Thirty-one patients with non-Hodgkin's lymphoma had stage Ⅳ disease at the time of diagnosis. Among these, 20 (65%) had the disease in bone marrow which was the most frequent site of stage Ⅳ disease. Furthermore, 1 (13%) of 8 patients with stage I, 3 (19%) of 16 patients with stage Ⅱ and 5 (20%) of 25 patients with stage Ⅲ had a change of stage as a result of positive bone marrow examination. Non-Hodgkin's lymphoma patients with bone marrow involvement poorly responded to chemotherapy and had short survival time as compared to those without bone marrow involvement. During the course of therapy, 23 patients were found to have bone marrow involvement, and in 2 of these patients, bone marrow involvement was the only evidence of the disease. Comparison of bone marrow biopsy and simultaneously performed bone marrow aspiration showed that the biopsy more often gave a positive result than did the aspiration (84% vs. 42%). These results indicate that Jamshidi needle bone marrow biopsy is useful for accurate staging, planning therapy and evaluation of prognosis at the time of diagnosis as well as detecting the extralymphatic spread or relapse after the course of therapy in patients with malignant lymphoma.