Development and validation of a clinical prediction rule for bone marrow involvement in patients with Hodgkin lymphoma.
We developed a clinical prediction rule for bone marrow involvement (BMI) in Hodgkin lymphoma based on 826 patients and validated it in 654 additional patients. Independent prognostic factors for BMI were x1, B symptoms; x2, stage III/IV prior to bone marrow biopsy; x3, anemia; x4, leukocytes fewer than 6 x 10(9)/L; x5, age 35 years or older; and x6, iliac/inguinal involvement. Each factor was graded as x(i)=1, if present, or x(i)=0, if absent. A simplified score Zs=8x1+6x2+5x3+5x4+3x5+3x6-8 was assigned to each patient. The sensitivity, specificity, and positive and negative predictive value of this prediction rule was 97.8%, 51.5%, 10.6%, and 99.8%, respectively. In the validation group, they were 98.1%, 40.3%, 12.7%, and 99.6%. According to Zs value, 3 risk groups for BMI were defined: low risk (Zs<0, 44% of patients, 0.3% risk), standard risk (Zs, 0-9; 37% of patients; 4.2% risk), and high risk (Zs>or=10, 20% of patients, 25.5% risk). Patients with low risk (stage IA/IIA without anemia and leukopenia; stage IA/IIA, younger than 35 years, with either anemia or leukopenia but no inguinal/iliac involvement; and stage IIIA/IVA without any of these 4 risk factors) do not need bone marrow (BM) biopsy. Patients with standard risk should be staged with unilateral biopsy, but patients with high risk may benefit from bilateral biopsy.
Vassilakopoulos
Theodoros P
TP
Haematology Section, First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.
Angelopoulou
Maria K
MK
Constantinou
Nikos
N
Karmiris
Themistoklis
T
Repoussis
Panayiotis
P
Roussou
Paraskevi
P
Siakantaris
Marina P
MP
Korkolopoulou
Penelope
P
Kyrtsonis
Marie-Christine
MC
Kokoris
Styliani I
SI
Dimopoulou
Maria N
MN
Variamis
Eleni
E
Viniou
Nora-Athina
NA
Konstantopoulos
Konstantinos
K
Dimitriadou
Evangelia M
EM
Androulaki
Athina
A
Patsouris
Efstratios
E
Doussis-Anagnostopoulou
Ipatia A
IA
Panayiotidis
Panayiotis
P
Boussiotis
Vassiliki A
VA
Kittas
Christos
C
Pangalis
Gerassimos A
GA
D019046:Bone Marrow Neoplasms / Q000175:diagnosis*; D006689:Hodgkin Disease / Q000473:pathology*; D006801:Humans; D015994:Incidence; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012306:Risk; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index