To evaluate the clincopathologic features of pleural effusion in patients with lymphoproliferative disorders and to determine clinical variables that correlate with malignant pleural effusion and mortality in these patients.PATIENTS & METHODS: Medical records of 74 patients with lymphoproliferative disorders who were hospitalized on 79 occasions and underwent thoracentesis from 1993-2002 were reviewed. Their median age was 68 yrs (4-92) and M:F was 40:34. Fifty patients had non-Hodgkin lymphoma, 18 had CLL, and 6 had Hodgkin disease. Fifty-two patients had stage >= 3 disease and 37 had received prior chemotherapy. Of 79 cases, 32 had mediastinal/and or hilar lymphadenopathy and 22 had pulmonary infiltrates. Cytological examination was performed in all 79 specimens, whereas immunophenotyping and/or genetic study was done in 38 specimens. Fisher’ Exact test was carried out to determine clinical variables that correlated with malignant pleural effusion and hospital mortality.
Of 79 cases of pleural effusion, 40 were bilateral and 72 were exudates. Forty-six effusions were diagnosed as malignant, 32 as reactive and 2 as empyema. Six were chylous effusion and 4 of them were malignant. Among the clinical variables examined for their correlation with malignant effusion, presence of secondary cancer and pleural fluid total nucleated cell count >1000/ul were significantly correlated with malignant effusion with a relative risk of malignant effusion of 1.59 (95% CI 1.67-2.17) and 1.53 (95% CI 1.02-2.29) respectively. Twenty of 74 patients died during their hospitalization. Presence of pleural fluid:serum LDH ratio >1, pneumonia, and secondary cancer significantly correlated with increased mortality with relative risk of death of 9 (95% CI 2.26-35.83), 3.54 (95% CI 1.68-7.45), and 3.12 (95% CI 1.60-6.00) respectively.CONCLUSIONS: Malignant effusion is a common cause of pleural effusion in patients with lymphoproliferative disorders. Secondary cancer and a high pleural fluid neucleated cell count correlated with presence of a malignant effusion, whereas a high pleural fluid to serum LDH ratio, pneumonia and secondary cancer correlated with increased hospital mortality.
Pleural fluid examination can predict hospital mortality of patients with lymphoproliferative disorders.
A.K. Siddiqui, None.