1. ¹Clinical Institute of Medical and Chemical Laboratory Diagnostics, Division of Molecular Diagnostics, University of Vienna, Medical School, Währinger Gürtel, Vienna, Austria
2. ²Department of Internal Medicine I, Division of Hematology, University of Vienna, Medical School, Währinger Gürtel, Vienna, Austria
3. ³Department of Clinical Pathology, University of Vienna, Medical School, Währinger Gürtel, Vienna, Austria
4. ⁴Department of Medical Computer Sciences, Section of Clinical Biometrics, University of Vienna, Medical School, Währinger Gürtel, Vienna, Austria

Correspondence: Dr U Jaeger, Department of Internal Medicine I, Division of Hematology, University of Vienna, Medical School, Währinger Gürtel 18-20, A-1090 Vienna, Austria; Fax: +43 1 4026930; E-mail: ulrich.jaeger@akh-wien.ac.at

Received 21 October 2003; Accepted 18 February 2004; Published online 15 April 2004.

Abstract

The prognostic value of the detection of peripheral blood (PB) and/or bone marrow (BM) involvement by polymerase chain reaction (PCR) amplification of rearranged immunoglobulin heavy chain (IgH) and immunoglobulin kappa light chain (Ig) genes was evaluated in 155 patients with diffuse large B-cell lymphomas (DLBCL). Immunoglobulin gene rearrangements (IgR) were detected in 35/155 (23%) patients. The presence of IgR in PB/BM was related to clinical stage (CS I–III vs CS IV; P<0.001), histopathological detection of BM involvement (P<0.001), and the International Prognostic Index (P<0.001). IgR-positive cases had a significantly lower complete remission (CR) rate (18/35, 51%) than IgR-negative patients (85/120, 71%; P=0.042), and a significantly poorer overall survival (OAS) at 5 years (25 vs 66%; P<0.001). There was a significant difference in the estimated OAS at 5 years between patients with negative BM histology and negative PCR results (66%), patients with negative BM histology but positive IgR (37%), and patients with positive BM histology (12%). Our results indicate that molecular methods improve the accuracy of staging in patients with DLBCL and define a group of patients with normal bone marrow histology who have a significantly poorer OAS due to molecular detection of PB/BM involvement.