title: A large-scale study of bone marrow involvement in patients with Hodgkin's lymphoma.
abstract: This study was designed to identify variables that can predict bone marrow involvement (BMI) in Hodgkin's lymphoma (HL), and to analyze the benefit of bilateral over unilateral bone marrow trephine biopsy (BMB). From 1982 to 2000, BMB had been performed at diagnosis in 1161 patients with HL who had been followed from the institutions participating in the Piemonte Hodgkin's Disease Registry. Six hundred and sixteen patients (53%) had received bilateral BMB, and the remaining 545 patients (47%) received unilateral BMB. The relationships between BMB results and other clinical features were retrospectively studied with both univariate and multivariate analyses. Ninety-two patients (8%) showed BMI: 51 of them were staged with bilateral and 41 with unilateral BMB. Among the 92 patients with BMI, a second extranodal involvement was present in only 25 patients (27%). In multivariate analysis, the 5 independent factors that predicted for BMI were B symptoms, infradiaphragmatic involvement, mixed cellularity (MC) and lymphocyte depleted (LD) histology, involvement of > or = 4 lymphatic areas, and liver involvement. The probability of BMI according to the presence of these variables was distributed as follows: 0.3%, 2.5%, 7.6%, and 27% in patients positive for 0, 1, 2, and > or = 3 factors, respectively. Among 51 patients staged with bilateral BMB, BMI was shown in both specimens in 33 cases (65%), whereas the positivity was limited to only 1 of the 2 specimens in the remaining 18 cases (35%). A score based on 5 variables can predict the probability of BMI, and BMB could be avoided in patients with a score of 0 and a probability of BMI of < 0.5%. When BMB is needed, the superiority of bilateral over unilateral biopsy is suggested.
authors.affiliation: Hematology Division, Ospedale SS Antonio e Biagio, Alessandria, Italy. alevis@ospedale.al.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Levis
authors.forename: Daniela
authors.initials: D
authors.lastname: Pietrasanta
authors.forename: Laura
authors.initials: L
authors.lastname: Godio
authors.forename: Umberto
authors.initials: U
authors.lastname: Vitolo
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ciravegna
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Vito
authors.forename: Paolo
authors.initials: P
authors.lastname: Gavarotti
authors.forename: Tommasina
authors.initials: T
authors.lastname: Guglielmelli
authors.forename: Lorella
authors.initials: L
authors.lastname: Orsucci
authors.forename: Ermanno
authors.initials: E
authors.lastname: Raviolo
authors.forename: Delia
authors.initials: D
authors.lastname: Rota Scalabrini
authors.forename: Flavia
authors.initials: F
authors.lastname: Salvi
authors.forename: Anna
authors.initials: A
authors.lastname: Tonso
authors.forename: Massimo
authors.initials: M
authors.lastname: Aglietta
authors.forename: Mario
authors.initials: M
authors.lastname: Boccadoro
authors.forename: Andrea
authors.initials: A
authors.lastname: Gallamini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Saglio
authors.forename: Enzo
authors.initials: E
authors.lastname: Scassa
authors.forename: Eugenio
authors.initials: E
authors.lastname: Gallo
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001799:Blood Sedimentation; D001853:Bone Marrow / Q000473:pathology*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000097:blood / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies