PB1791 THE ROLE OF SURGERY IN BONE LYMPHOMA: WHAT IMPACT IT HAS ON SURVIVAL?

Background: bone lymphoma is an extra‐nodal lymphoma which runs either an aggressive or indolent course depending on affected site and pathologic subtype. Since it is a rare tumor, little data was reported about the role of surgery, benefit and timing. However, there is no consensus about the role of surgery since it represent a systemic disease. Aims: : this study is a retrospective one demonstrating the role of surgery in a series of patients diagnosed with bone lymphoma at different localizations treated with surgery at diagnosis or later during the course of treatment with an overall survival at 5 years as a primary end point. Methods: this is a multicenter retrospective study where we have reviewed 112 cases with bone lymphoma with only 59 patients fitting the criteria (surgery) between 2005 and 2012. Affected sites distributed as follows: 19 in the vertebral column, 8 in the pelvis, 6 in humorous, 2 in the mandible and the remaining 24 in the femur and femoral neck. 32 patients (54%) are operated at the very beginning as an emergency procedure in order to correct disability, pain control and to get a sample to reach the diagnosis as well. Pathology was diffuse large B‐cell lymphoma in 54 patients vs indolent lymphoma in the remaining 5 patients. Most patients are treated with R‐CHOP and R‐CHOP like regimen. Results: Response rate was slow and partial on those who were not operated at diagnosis, however, local control was improved after surgery performed at the end of chemotherapy. All patients were treated by radiotherapy as well. 53 patients were reported alive after 5 years of follow up with an overall survival rate of (89.8%). Local control was better in those with femoral localization (p. value 0.02). factors affecting survival were high international prognostic index (IPI) score, high LDH score, bone biopsy positive disease, older age of patient and patient with high weight, however, p. values did not statistically significant. Summary/Conclusion: primary bone lymphoma is a rare disease which can be treated by different approaches such as surgery, chemotherapy and radiotherapy. Few data was published on this type of lymphoma which is diagnosed without the knowledge of hematologists making treatment guidelines hard to be established. However, in our retrospective study, we have demonstrated the important role of surgery in restoring limb function which has in turn a positive impact on both social and psychological status of patients making them more ready to continue chemotherapy with a good performance status. Therefore, we highly recommend surgery at the time of diagnosis.