Comparison With Small Noncleaved Cell Lymphoma Involving the Bone Marrow

The relationship between acute lymphoblastic leukemia (ALL-L3) and stage IV small noncleaved cell lymphoma with bone marrow involve­ ment (SNCL) was analyzed by retrospective study of 45 patients. Twelve patients with ALL-L3 had tumor restricted to the marrow and blood with no evidence of an extramedullar) tumor at their initial pre­ sentation. Nineteen patients with stage IV SNCL had evidence of extramedullary disease in addition to marrow and blood involvement. Four­ teen patients with marrow and blood involvement by SNCL at the time of a first or second relapse were also studied. The median age of the ALL-L3 patients was 33.5 years, compared with 13 years for the pa­ tients with stage IV SNCL and 10.5 years for the marrow relapse pa­ tients. All of the ALL-L3 patients were male; the male:female ratio for the SNCL patients was 17:2; for the relapse group, 9:5. The majority of the ALL-L3 patients had symptoms related to bone marrow failure; the majority of the SNCL patients had symptoms related to a tumor mass. Acute lymphoblastic leukemia (ALL-L3), a leukemia of B cells, shows morphologic, cytogenetic, and immunologic identity with small noncleaved cell lymphoma (SNCL). The distinction between these two processes is usually made on clinical presen­ tation: ALL-L3 is diagnosed when there is marrow involve­ ment without evidence of a tissue mass, and the term SNCL is used when there is an extramedullary lesion with or without concurrent marrow involvement. The study compared the clinical features, cytomorphology, laboratory findings, and survival for patients with ALL-L3 and patients with SNCL involving the bone marrow at initial diag­ nosis to assess whether the two lymphoproliferative processes are, in fact, different manifestations of the same disease. In addition, we present the clinical features, laboratory findings, and survival data for patients who had bone marrow involve­ ment by SNCL at the time of a first or second relapse.