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Study of Bone Marrow Involvement in 1161 Consecutive Hodgkin's Lymphoma Patients.

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

• 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 positive BMI:

1. B symptoms
2. infra-diaphragmatic involvement
3. mixed cellularity or lymphocyte depleted histology
4. more than 3 involved sites
5. 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.