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Study of Bone Marrow Involvement in 1161 Consecutive Hodgkin's Lymphoma
Reviewer: William Levin, MD
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: December 8, 2001
Presenter: Alessandro Lewis
Affiliation: Piemonte Hodgkin's Disease Registry. Alessandria, Italy
Materials and Methods
- In Hodgkin's Disease(HD) bone marrow involvement(BMI) has been reported as a unfavorable prognostic factor. Accordingly, bone marrow biopsy(BMB) is frequently used in staging of disease.
- Increasingly, the utility of this procedure in early stage disease(Stage IA & IIA)has been questioned.
- In this study the authors try to identify factors that predict for BMI, so that those patients at low risk can avoid BMB as a part of staging.
- From 1982-2000, 1161 HD patients underwent BMB as a part of their staging.
- Median age was 37 years old
- 19% had bulky disease
- 39% had B symptoms
- 57% were male
- 56% had supra-diaphragmatic involvement, 9% infra-diaphragmatic disease, and 35% with both
- 59% had nodular sclerosis histology, 30% mixed cellularity, and 4% lymphocyte depleted
- 946 patient cases underwent multivariate analysis in an attempt to identify factors related to BMI.
Five main independent variables were identified that predicted for
- B symptoms
- infra-diaphragmatic involvement
- mixed cellularity or lymphocyte depleted histology
- more than 3 involved sites
- liver involvement.
- Predictive models based on these clinical factors could be formulated to
- help identify those patients with a low risk of BMI, and thus avoid BMB in
- these patients.
- Bone marrow biopsy is not a simple risk free procedure.
- It can be very painful and anxiety provoking for the patient as well as be a potential source of serious infection.
- Identifying those patients at very low risk for bone marrow involvemnt would help reduce the number of unecessary procedures in the staging of Hodgkin's Disease.