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

Melissa R. Hines-Thomas, Scott Howard, Melissa M. Hudson, Matthew J. Krasin, Sue C. Kaste, Barry L. Shulkin, Monika L. Metzger

Research output: Contribution to journalArticle

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Abstract

Background Bone 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 Methods We 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. Results Of 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). Conclusions Although 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.

Original languageEnglish (US)
Pages (from-to)1691-1696
Number of pages6
JournalHaematologica
Volume95
Issue number10
DOIs
StatePublished - Oct 1 2010

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Hodgkin Disease
Bone Marrow
Pediatrics
Biopsy
Survival
Recurrence
Therapeutics
Prospective Studies
Drug Therapy
Research

All Science Journal Classification (ASJC) codes

  • Hematology

Cite this

Hines-Thomas, M. R., Howard, S., Hudson, M. M., Krasin, M. J., Kaste, S. C., Shulkin, B. L., & Metzger, M. L. (2010). Utility of bone marrow biopsy at diagnosis in pediatric Hodgkin's lymphoma. Haematologica, 95(10), 1691-1696. https://doi.org/10.3324/haematol.2010.025072

Utility of bone marrow biopsy at diagnosis in pediatric Hodgkin's lymphoma. / Hines-Thomas, Melissa R.; Howard, Scott; Hudson, Melissa M.; Krasin, Matthew J.; Kaste, Sue C.; Shulkin, Barry L.; Metzger, Monika L.

In: Haematologica, Vol. 95, No. 10, 01.10.2010, p. 1691-1696.

Research output: Contribution to journalArticle

Hines-Thomas, MR, Howard, S, Hudson, MM, Krasin, MJ, Kaste, SC, Shulkin, BL & Metzger, ML 2010, 'Utility of bone marrow biopsy at diagnosis in pediatric Hodgkin's lymphoma', Haematologica, vol. 95, no. 10, pp. 1691-1696. https://doi.org/10.3324/haematol.2010.025072
Hines-Thomas MR, Howard S, Hudson MM, Krasin MJ, Kaste SC, Shulkin BL et al. Utility of bone marrow biopsy at diagnosis in pediatric Hodgkin's lymphoma. Haematologica. 2010 Oct 1;95(10):1691-1696. https://doi.org/10.3324/haematol.2010.025072
Hines-Thomas, Melissa R. ; Howard, Scott ; Hudson, Melissa M. ; Krasin, Matthew J. ; Kaste, Sue C. ; Shulkin, Barry L. ; Metzger, Monika L. / Utility of bone marrow biopsy at diagnosis in pediatric Hodgkin's lymphoma. In: Haematologica. 2010 ; Vol. 95, No. 10. pp. 1691-1696.
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abstract = "Background Bone 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 Methods We 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. Results Of 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). Conclusions Although 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.",
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AU - Shulkin, Barry L.

AU - Metzger, Monika L.

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N2 - Background Bone 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 Methods We 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. Results Of 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). Conclusions Although 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.

AB - Background Bone 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 Methods We 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. Results Of 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). Conclusions Although 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.

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