Pan-immune-inflammation value and bone marrow infiltration in lymphoma: a retrospective cross-sectional study

Background Lymphoma, a prevalent hematologic malignancy, utilizes bone marrow infiltration (MI) as a key prognostic indicator. The pan-immune-inflammation value (PIV), an emerging systemic inflammatory metric in translational oncology, correlates with adverse outcomes in lymphoma, but its specific association with MI has not been established. This study aimed to evaluate the relationship between PIV and MI in lymphoma patients. Methods This retrospective cross-sectional study included 309 consecutive patients with newly diagnosed lymphoma at the Third Affiliated Hospital of Sun Yat-sen University between January 2018 and January 2024. Multivariable-adjusted logistic regression was used to evaluate the independent association between PIV and MI. Trend analysis was performed using smooth curve fitting, and stratified analyses were conducted to assess potential effect modification. Results Bone marrow infiltration was present in 108 of 309 patients (35.0%). After multivariable adjustment, higher PIV was inversely associated with MI. Each 10-fold increase in PIV (log₁₀-transformed) corresponded to 83% lower odds of bone marrow infiltration (adjusted OR = 0.17, 95% CI 0.10–0.30; P < 0.001). Multivariable smooth spline analysis supported a linear inverse association between PIV and MI ( P for non-linearity = 0.433). These findings were consistent in sensitivity analyses and propensity score-matched multivariable models. Conclusions PIV was inversely associated with bone marrow infiltration in lymphoma patients. These findings suggest that PIV may be a candidate biomarker for MI; however, its diagnostic and predictive performance, clinical decision thresholds, and incremental value beyond established parameters were not evaluated. Therefore, PIV is not yet ready for routine clinical use, and prospective multicenter studies with external validation are warranted.