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 Background
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.
Materials and Methods
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
mixed cellularity or lymphocyte depleted histology
more than 3 involved sites
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
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.
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