Bone Marrow Histology in Waldenström's Macroglobulinaemia

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Abstract
Bone marrow biopsies of 137 patients with Waldenstrom''s macroglobulinemia (WM), 26 with non-secretory immunocytoma and 32 with benign monoclonal gammopathy were processed for histologic evaluation. Bone marrow involvement was found in 110 (80%) initially, and in 24 (18%) in sequential biopsies. Three types were distinguished: lymphoplasmacytoid (47%), lymphoplasmacytic (42%) and polymorphous (11%) with median survivals of 74, 25 and 12 mo., respectively. When grouped according to the tumor cell mass in the biopsies, the median survivals were 55, 21 and 8 mo. for < 20 vol%, 20-50 vol% and > 50 vol%, respectively; in each subtype, the tumor cell mass correlated with the disease progression. Six clinical variables were prognostically significant. Of patients with WM, 98% have bone marrow involvement. The lymph node sub-classification is applicable to the bone marrow and has clinical and prognostic significance. Patients may be staged according to the tumor cell burden in the bone marrow biopsy.