Subject(s)
Histiocytic Sarcoma/pathology , Leukemia, Megakaryoblastic, Acute/pathology , Mediastinal Neoplasms/pathology , Neoplasms, Germ Cell and Embryonal/pathology , Neoplasms, Multiple Primary , Adult , Carcinoma, Embryonal/complications , Carcinoma, Embryonal/pathology , Chest Pain/etiology , Cough/etiology , Endodermal Sinus Tumor/complications , Endodermal Sinus Tumor/pathology , Fatal Outcome , Fatigue/etiology , Fever/etiology , Gastrointestinal Hemorrhage/etiology , Humans , Leukemia, Megakaryoblastic, Acute/complications , Leukemic Infiltration , Male , Mediastinal Neoplasms/complications , Neoplasms, Germ Cell and Embryonal/complications , Teratocarcinoma/pathology , Teratoma/complications , Teratoma/pathology , Testis/pathologyABSTRACT
BACKGROUND: The clinical relevance of bone marrow micrometastases in non-small cell lung cancer (NSCLC) is undetermined, and the value of such analyses in advanced stage patients has not been assessed previously. METHODS: Immunomagnetic selection with the MOC31 (anti-EpCam) antibody was performed to isolate and detect tumor cells in bone marrow aspirates obtained from 196 patients with NSCLC, and the patients were subjected to follow-up for the assessment of survival. Repeated bone marrow samples, 2-7 samples per patient, were obtained from 13 long-term survivors. RESULTS: MOC31 positive tumor cells were detected in 107 of 196 (55%) samples, a frequency similar to results reported in low-stage patients prior to curative surgical resection for NSCLC. No association was found between the presence of bone marrow micrometastases and disease stage or histological subgroup, and survival was similar in patients with and without detectable tumor cells in bone marrow. Repeated bone marrow analysis revealed, for the first time in this group of patients, the continued presence of tumor cells regardless of the given therapy and treatment response. CONCLUSION: The immunomagnetic method utilized is a feasible strategy for the detection of bone marrow micrometastases in NSCLC. In advanced stage patients, the presence of MOC31 positive cells in bone marrow does not predict survival. Repeated analyses of bone marrow samples from long-term survivors revealed tumor cells in bone marrow which may represent dormant cells of particular interest for further characterization and follow-up.
Subject(s)
Antigens, Neoplasm/metabolism , Bone Marrow Neoplasms/secondary , Bone Marrow/metabolism , Carcinoma, Non-Small-Cell Lung/pathology , Cell Adhesion Molecules/metabolism , Lung Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Antigens, Neoplasm/immunology , Bone Marrow/pathology , Bone Marrow Neoplasms/metabolism , Bone Marrow Neoplasms/mortality , Carcinoma, Non-Small-Cell Lung/metabolism , Carcinoma, Non-Small-Cell Lung/mortality , Cell Adhesion Molecules/immunology , Epithelial Cell Adhesion Molecule , Female , Follow-Up Studies , Humans , Immunohistochemistry , Immunomagnetic Separation , Lung Neoplasms/metabolism , Lung Neoplasms/mortality , Male , Middle Aged , Neoplasm Staging , Survival Analysis , Time FactorsABSTRACT
Soluble transferrin receptor levels in serum (s-sTfR) may be useful in differentiating between iron deficiency anemia and anemia of chronic disease. However, there is both theoretical and clinical evidence for elevated s-sTfR levels in patients with various hematological malignancies. In the present study, routine bone marrow aspirations were performed in 82 patients with malignant lymphomas (63 with non-Hodgkin's lymphoma and 19 with Hodgkin's disease). Smears were stained for evaluation of iron stores and graded. Patients were also given a disease score based on bone marrow morphology, erythrocyte sedimentation rate and LDH. s-sTfR levels correlated better with disease score [partial Spearman rank correlation coefficient (r(s)) controlled for iron stores was 0.51 (95% confidence interval 0.39-0.65); p < 0.001] than with iron stores [partial r(s) controlled for disease score was -0.25 (95% confidence interval -0.44 to -0.03); p = 0.027]. This study showed elevated s-sTfR levels in patients with malignant lymphomas without any signs of iron deficiency anemia. The diagnosis of iron deficiency anemia should not be established upon the basis of s-sTfR alone in this group of patients.
