Role of staging bone marrow examination in children with Hodgkin disease

Mahoney, Donald H.; Schreuders, L.C.; Gresik, Mary V.; McClain, Kenneth L.

doi:10.1002/(sici)1096-911x(199803)30:3<175::aid-mpo9>3.0.co;2-e

Cited by 17 publications

(11 citation statements)

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“…Other studies of HL in childhood have addressed clinical predictors of BM involvement and the subsets of patients who should undergo BM biopsy, [7][8][9] but not the value and prognostic significance of BM involvement at diagnosis. This question has been investigated in several studies of adults with HL, but the results have been inconsistent.…”

Section: Discussionsupporting

confidence: 43%

“…18,23,24 In previous pediatric studies, the incidence of BM involvement at diagnosis ranged from 1.8% to 6.5%. [7][8][9] In our study, the incidence was 5.5% in the whole cohort. Importantly, although this incidence appears comparable to the incidences found in the previous studies, all patients included in those studies had undergone BM biopsy, 7-9 as compared to approximately 60% of our study group.…”

Section: Discussionmentioning

confidence: 99%

“…8 Both patients experienced relapse, and one eventually died of HL; however, the small size of the cohort did not allow analysis of the prognostic impact of BM involvement. 8 In our cohort, 21 of 228 (9%) BM biopsies performed at diagnosis were positive, but only two of these patients experienced relapse and only one died of HL. We also found that, as in adults, 2,3,18 BM involvement did not significantly affect the relapse-free survival or overall survival of patients with stage IV HL, nor did it carry any prognostic disadvantage in stage IV HL.…”

Section: Discussionmentioning

confidence: 99%

“…Overall survival probability © F e r r a t a S t o r t i F o u n d a t i o n therapy of patients with BM involvement in their cohorts did not change on the basis of BM biopsy findings. 7,8 BM biopsy findings also did not change the initial management of adults with HL. 4,22 With the increasing sensitivity of imaging modalities, more extranodal sites of disease are being detected, leading to upstaging of patients at diagnosis and possibly leading to a decreased number of patients being upstaged because of BM biopsy findings.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] In pediatric patients, BM involvement is associated with higher disease stage, B symptoms, [5][6][7] and, in one study, anemia. 7 Because BM involvement is detected in less than 1% of adults 2,6 and less than 2% of children with stage IA and IIA disease, [7][8][9] staging practice reserves BM biopsy at diagnosis for patients who have unfavorable risk features. While clinical research has focused on predictive models for BM involvement in adult and pediatric HL, 9,10 it is still uncertain whether BM involvement alters the treatment or the prognosis of patients treated with combinedmodality therapy.…”

Section: Introductionmentioning

confidence: 99%

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Utility of bone marrow biopsy at diagnosis in pediatric Hodgkin's lymphoma

Hines-Thomas¹,

Howard²,

Hudson³

et al. 2010

Haematologica

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BackgroundBone marrow biopsy is considered essential for the staging and risk-adapted treatment of Hodgkin's lymphoma with unfavorable risk features. We reviewed the cases of pediatric Hodgkin's lymphoma in our institution to determine the impact of bone marrow involvement on treatment, relapse, and survival. Design and MethodsWe reviewed the clinical characteristics and outcome of 383 patients treated for Hodgkin's lymphoma at St. Jude Children's Research Hospital between August 1990 and August 2008. The 5-year survival estimates for patients with and without bone marrow involvement were compared. ResultsOf 228 patients who had a bone marrow biopsy at diagnosis, 21 had bone marrow involvement. Bone marrow findings changed the disease stage in only seven patients (3.1%): from IB to IVB (n=1), from IIA (with bulky disease) to IVA (n=1), from IIB to IVB (n=1), and from IIIB to IVB (n=4). One patient's risk assignment changed from intermediate to unfavorable risk without his chemotherapy being altered. No statistically significant difference was observed between patients with stage IV Hodgkin's lymphoma who did (n=21) and did not (n=61) have bone marrow involvement in 5-year relapse-free survival (89.6± 7% versus 73.9±6.1%; P=0.25) or 5-year overall survival (95.2±8.2% versus 87.3±4.9%; P=0.82). ConclusionsAlthough bone marrow involvement changed the stage in 3.1% of pediatric Hodgkin's lymphoma patients, it did not change risk-adapted treatment or prognosis. We conclude that bone marrow biopsy need not be performed at diagnosis in patients who have unfavorable risk features, although this finding should be confirmed by larger prospective studies.Key words: bone marrow, risk features, Hodgkin's lymphoma. 's lymphoma. Haematologica 2010;95(10):1691-1696. doi:10.3324/haematol.2010 This is an open-access paper. © F e r r a t a S t o r t i F o u n d a t i o n Citation: Hines-Thomas MR, Howard SC, Hudson MM, Krasin MJ, Kaste SC, Shulkin BL, and Metzger ML. Utility of bone marrow biopsy at diagnosis in pediatric Hodgkin Utility of bone marrow biopsy at diagnosis in pediatric Hodgkin's lymphoma

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Section: Discussionsupporting

confidence: 43%