Bone marrow biopsy in the initial staging of Hodgkin's disease

Doll, Donald C.; Ringenberg, Q. Scott; Anderson, Sharon; Hewett, John E.; Yarbro, John W.

doi:10.1002/mpo.2950170102

Cited by 17 publications

(13 citation statements)

References 22 publications

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“…Examination of the patients treated at our institution over the past 27 years demonstrated that bone marrow involvement is rare in paediatric patients with HL. The incidence of bone marrow involvement was 6AE5% (4/62), and was consistent with adult studies that demonstrated an incidence of 4AE8-18% (Menon & Buchanan, 1979;Doll et al, 1989;Ellis et al, 1989;Munker et al, 1995;Howell et al, 2002;Vassilakopoulos et al, 2005). Our incidence was higher than in the paediatric study reported by Mahoney et al (1AE8%), which may be attributed to the fact that our institution routinely performs bilateral BME, which was not performed consistently in their report.…”

Section: Discussionsupporting

confidence: 89%

“…The most consistently reported risk factors for bone marrow involvement in adult HL include advanced age, the presence of ‘B’ symptoms, anaemia, leucopenia, thrombocytopenia and advanced clinical stage (Doll et al , 1989; Ellis et al , 1989; Munker et al , 1995; Spector et al , 1997; Howell et al , 2002; Vassilakopoulos et al , 2005). Those respondents to our survey, who did not perform routine BME, were influenced to do so by the presence of ‘B’ symptoms, cytopenias and bulky disease.…”

Section: Discussionmentioning

confidence: 99%

“…There is a paucity of evidence‐based recommendations for BME in paediatric HL patients. Several studies (Doll et al , 1989; Ellis et al , 1989; Munker et al , 1995; Spector et al , 1997; Vassilakopoulos et al , 2005) have investigated the role of a staging BME in HL in adults and have identified a number of predictors or risk factors for bone marrow involvement including ‘B’ symptoms, clinical stage, haemoglobin, leucocyte count, platelet count, erythrocyte sedimentation rate, serum levels of lactate dehydrogenase and alkaline phosphatase, splenic and iliac/inguinal involvement, lymph node involvement on both sides of the diaphragm and histological subtype. Recommendations have been made to limit BME in adults according to these specific risk factors.…”

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confidence: 99%

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Routine bone marrow examination in the initial evaluation of paediatric Hodgkin lymphoma: the Canadian perspective

et al. 2008

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SummaryBone marrow examination (BME) in paediatric Hodgkin lymphoma (HL) was evaluated, as evidence from adult HL suggests it may be unnecessary. An internet-based survey was used to examine the practice of Canadian paediatric oncologists regarding BME in children and the impact of routine BME was evaluated in patients with HL treated at our institution. Sixteen of 17 paediatric oncology centres were represented. Forty-three percent of eligible doctors completed the survey. Routine BME for stages III and IV disease was consistent nationally. By contrast, 54% and 70% of respondents reported performing routine BME for stages I and II HL respectively. Respondents were more likely to report performing routine BME in low-stage HL if trained outside Canada (P = 0AE04, stage I; P = 0AE07, stage II) or practicing at smaller centres (P = 0AE05, stage I; P = 0AE03, stage II). At our institution, 62 patients were eligible for analysis. Only four patients (6AE5%) had a positive BME. Anaemia was the only significant risk factor (P = 0AE006). No patient with otherwise low stage was found to have marrow involvement. Comparison of staging with and without BME demonstrated no significant difference to final risk classification. BME in paediatric patients with low-stage HL has extremely low yield and may be unnecessary.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Routine bone marrow examination in the initial evaluation of paediatric Hodgkin lymphoma: the Canadian perspective

et al. 2008

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“…Among stage IV patients, 32% have BM involvement (3). However, the value of BMB in the staging of patients with HL is controversial, because the BM involvement in patients with prebioptic stage IA or IIA has been shown to be very rare in most series (4). In addition there is no consensus about the impact of BM infiltration on prognosis (5, 6).…”

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confidence: 99%

Bone marrow biopsy in Hodgkin's lymphoma

Franco

Tripodo

Rizzo

et al. 2004

European J of Haematology

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: In the study of patients with Hodgkin's lymphoma (HL) the evaluation of bone marrow biopsy (BMB) can be difficult. In this review we analyze the main diagnostic features and the clinical risk factors of BM involvement. Although the role of BMB is criticized by some authors, its value is irreplaceable in the staging of HL and in the diagnosis of primary medullary HL. The Ann Arbor staging committee criteria should be revised and updated in the light of the current immunohistochemical studies that give a fundamental help in the diagnostic process. A single BMB should be adequate for diagnosis in most instances. In cases of suspicious involvement a controlateral BMB could be performed.

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“…disseminated involvement of an extra‐nodal organ. However, the incidence of BMI in patients otherwise staged as clinical stage (CS) IA or IIA has been shown to be < 1% in most series (Macintyre et al , 1987; Doll et al , 1989; Munker et al , 1995; Spector et al , 1997). In CS IV HL, marrow infiltration has previously been thought to confer a relatively poorer prognosis over patients without BMI (Rosenberg, 1971; Specht & Nissen, 1988).…”

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confidence: 99%

The value of bone marrow examination in the staging of Hodgkin's lymphoma: a review of 955 cases seen in a regional cancer centre

Howell

Grey²,

Chang³

et al. 2002

Br J Haematol

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Summary. Bone marrow aspirates (BMA) and trephine biopsies (BMT) are commonly performed in the staging of patients with newly diagnosed Hodgkin's lymphoma (HL) but the value of these procedures is controversial. The purpose of this study was to evaluate the predictive value of the blood count and erythrocyte sedimentation rate (ESR) for bone marrow involvement (BMI) and the influence of BMI on stage and prognostic score. A retrospective analysis of 955 patients with newly diagnosed HL entered into clinical trials in a regional cancer centre between 1975 and 1999 was performed. BMI was identified by BMT in 50 patients (5AE2%) but in only five of these by BMA. The negative predictive values of a normal full blood count (FBC) and ESR for absence of BMI were 98AE8% and 97AE3%, respectively, and the positive predictive value of an abnormal FBC and ESR for presence of BMI were both 6AE7%. BMT did not alter initial patient management in a single case but provided valuable prognostic information in certain subgroups of patients. BMA gave no additional staging information over BMT and abnormalities of blood count and ESR were poor predictors of infiltration. We conclude that BMA should be abandoned for staging purposes in HL and BMT restricted to patients with stage IIB or III disease, for whom valuable prognostic information may be obtained.

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Bone marrow biopsy in the initial staging of Hodgkin's disease

Cited by 17 publications

References 22 publications

Routine bone marrow examination in the initial evaluation of paediatric Hodgkin lymphoma: the Canadian perspective

Routine bone marrow examination in the initial evaluation of paediatric Hodgkin lymphoma: the Canadian perspective

Bone marrow biopsy in Hodgkin's lymphoma

The value of bone marrow examination in the staging of Hodgkin's lymphoma: a review of 955 cases seen in a regional cancer centre

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