title: Can patients with early-stage diffuse large B-cell lymphoma be treated without bone marrow biopsy?
abstract: BACKGROUND
  Data on the incidence of bone marrow (BM) involvement in early-stage diffuse large B-cell lymphoma (DLBCL) are lacking. Although BM biopsy is a safe procedure, it is often poorly tolerated. This analysis aims to assess the incidence of BM involvement and to identify parameters predicting BM involvement in early-stage DLBCL.
  
  
  METHODS
  One hundred and ninety-two patients with radiological stages 1 and 2 disease were analysed. The data collected were age, sex, presence of B symptoms, white blood cell (WBC) count, platelet count, haemoglobin (Hb), serum lactate dehydrogenase level, serum beta(2)-microglobulin level, presence of extranodal disease, and the presence of bulky disease (defined as >7 cm).
  
  
  RESULTS
  Overall incidence of BM involvement was 3.6%. Hb < 10 g/dl (P=0.02), WBC count < 4 x 10(9)/l (P=0.007) and bulky disease (P=0.06) were found to be predictive of BM involvement. Among the 120 patients without any of these three factors, only one patient had BM involvement (0.83%; 95% confidence interval 0.02% to 4.6%). The absence of all three factors gave a negative predictive value of 99.2%. Overall 3-year survival for patients without all three risk factors was 80%.
  
  
  CONCLUSIONS
  BM biopsy may be safely omitted in selected patients with early-stage DLBCL.
authors.affiliation: Department of Medical Oncology, National Cancer Centre, 11 Hospital Drive, 169610 Singapore. dmolst@nccs.com.sg
authors.forename: S T
authors.initials: ST
authors.lastname: Lim
authors.forename: M
authors.initials: M
authors.lastname: Tao
authors.forename: Y B
authors.initials: YB
authors.lastname: Cheung
authors.forename: S
authors.initials: S
authors.lastname: Rajan
authors.forename: B
authors.initials: B
authors.lastname: Mann
mesh_terms: D001856:Bone Marrow Examination / Q000009:adverse effects; D019046:Bone Marrow Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins; D006801:Humans; D007958:Leukocyte Count; D016393:Lymphoma, B-Cell / Q000473:pathology* / Q000628:therapy; D016403:Lymphoma, Large B-Cell, Diffuse / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D006454:Hemoglobins