title: Development and validation of a clinical prediction rule for bone marrow involvement in patients with Hodgkin lymphoma.
abstract: 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.
authors.affiliation: Haematology Section, First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.
authors.forename: Theodoros P
authors.initials: TP
authors.lastname: Vassilakopoulos
authors.forename: Maria K
authors.initials: MK
authors.lastname: Angelopoulou
authors.forename: Nikos
authors.initials: N
authors.lastname: Constantinou
authors.forename: Themistoklis
authors.initials: T
authors.lastname: Karmiris
authors.forename: Panayiotis
authors.initials: P
authors.lastname: Repoussis
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Roussou
authors.forename: Marina P
authors.initials: MP
authors.lastname: Siakantaris
authors.forename: Penelope
authors.initials: P
authors.lastname: Korkolopoulou
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Kyrtsonis
authors.forename: Styliani I
authors.initials: SI
authors.lastname: Kokoris
authors.forename: Maria N
authors.initials: MN
authors.lastname: Dimopoulou
authors.forename: Eleni
authors.initials: E
authors.lastname: Variamis
authors.forename: Nora-Athina
authors.initials: NA
authors.lastname: Viniou
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Konstantopoulos
authors.forename: Evangelia M
authors.initials: EM
authors.lastname: Dimitriadou
authors.forename: Athina
authors.initials: A
authors.lastname: Androulaki
authors.forename: Efstratios
authors.initials: E
authors.lastname: Patsouris
authors.forename: Ipatia A
authors.initials: IA
authors.lastname: Doussis-Anagnostopoulou
authors.forename: Panayiotis
authors.initials: P
authors.lastname: Panayiotidis
authors.forename: Vassiliki A
authors.initials: VA
authors.lastname: Boussiotis
authors.forename: Christos
authors.initials: C
authors.lastname: Kittas
authors.forename: Gerassimos A
authors.initials: GA
authors.lastname: Pangalis
mesh_terms: 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