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Primary and secondary bone lymphomas

  • Author Footnotes
    1 International Extranodal Lymphoma Study Group.
    Carlo Messina
    Footnotes
    1 International Extranodal Lymphoma Study Group.
    Affiliations
    Unit of Lymphoid Malignancies, Department of Onco-Haematology, San Raffaele Scientific Institute, Milan, Italy
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  • Author Footnotes
    1 International Extranodal Lymphoma Study Group.
    David Christie
    Footnotes
    1 International Extranodal Lymphoma Study Group.
    Affiliations
    Genesiscare and Bond University, Inland Dr., Tugun, QLD, Australia
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  • Author Footnotes
    1 International Extranodal Lymphoma Study Group.
    Emanuele Zucca
    Footnotes
    1 International Extranodal Lymphoma Study Group.
    Affiliations
    Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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  • Author Footnotes
    1 International Extranodal Lymphoma Study Group.
    Mary Gospodarowicz
    Footnotes
    1 International Extranodal Lymphoma Study Group.
    Affiliations
    Department of Radiation Oncology, Princess Margaret Hospital, Ontario Cancer Institute, Toronto, ON, Canada
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  • Author Footnotes
    1 International Extranodal Lymphoma Study Group.
    Andrés J.M. Ferreri
    Correspondence
    Corresponding author at: Unit of Lymphoid Malignancies, Division of Onco-Hematological Medicine, Department of Onco-Hematology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy. Tel.: +39 02 26437649; fax: +39 02 26437625.
    Footnotes
    1 International Extranodal Lymphoma Study Group.
    Affiliations
    Unit of Lymphoid Malignancies, Department of Onco-Haematology, San Raffaele Scientific Institute, Milan, Italy
    Search for articles by this author
  • Author Footnotes
    1 International Extranodal Lymphoma Study Group.
Published:February 06, 2015DOI:https://doi.org/10.1016/j.ctrv.2015.02.001

      Highlights

      • Three clinical forms of bone lymphoma exist: the primary, the polyostotic and the secondary bone lymphoma.
      • Level of evidence supporting therapeutic decisions in these rare tumors is low, and prospective trials appear unrealistic.
      • This review is based on the analysis of the largest available database of bone lymphomas and of relevant literature.
      • We provide recommendations for diagnosis, staging and treatment of patients with bone lymphoma in everyday practice.
      • Special conditions like pathological fractures, indolent lymphomas and central nervous system prophylaxis are also discussed.

      Abstract

      Recent studies have contributed to the enhancement of clinical and molecular knowledge on bone lymphomas, a group of rare malignancies with particular characteristics. Nevertheless, several questions remain unanswered and the level of evidence supporting some diagnostic and therapeutic decisions remains low. Currently, three different forms of bone lymphomas can be distinguished: the primary bone lymphoma, consisting of a single bone lesion with or without regional lymphadenopathies; the polyostotic lymphoma, consisting of multifocal disease exclusively involving the skeleton; and the disseminated lymphoma with secondary infiltration of the skeleton. The first two forms exhibit a good prognosis, requiring treatments similar to those commonly used for nodal lymphomas of the same category, but several issues regarding the role of surgery and local control of the disease, the sequence of treatment, radiation volumes and doses, management of pathological fractures and prevention of late sequelae deserve particular attention. Due to its rarity, prospective trials exclusively focused on bone lymphomas appear unrealistic, thus, critical revision of our own experience and analyses of large cumulative series as well as molecular studies on archival cases remain valid alternatives to improve our knowledge on this obscure lymphoproliferative malignancy.
      The present review is based on the analysis of the largest available database of bone lymphomas established under the sponsorship of the International Extranodal Lymphoma Study Group (IELSG) as well as on the critical revision of related literature. We provide recommendations for diagnosis, staging, treatment, and response assessment of these patients in everyday practice as well as for the management of special conditions like pathological fractures, indolent forms and central nervous system prophylaxis.

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