Bone Marrow Biopsy Findings in Patients with Hepatitis C Infection

Abstract Abstract 4840 Patients with hepatitis C often present with cytopenias - thrombocytopenia, neutropenia and less commonly anemia. Hypersplenism may contribute to cytopenias but effects on the bone marrow due to the hepatitis C infection also likely play a role in its pathogenesis. Hepatitis C infection predisposes to development of lymphomas as well. The bone marrow findings in patients with hepatitis C infection are not well described and to our knowledge there has only been one peer reviewed study published till date. In order to elucidate this further, we conducted a retrospective review of bone marrow biopsies performed at our institution on patients with known hepatitis C infection. Between years 1999 and 2010, 56 adults (36 male and 20 female) patient with hepatitis C underwent bone marrow biopsies. The indications for bone marrow biopsy included evaluation or staging of lymphoma or myeloma (24 patients) OR investigation of cytopenias (32 patients). None of the patients were on treatment for Hepatitis C at the time of the bone marrow biopsy. Of the 24 patients with lymphoma/myeloma, 11 showed bone marrow involvement, while 10 patients had benign lymphocyte aggregates in the marrow. 9 out of 24 patients had a hypercellular marrow and 8 had a hypocellular marrow. Mild to moderate megaloblastic change in the erythrocyte series was seen in 5 patients and dyserythropoiesis in 2. Hyperplasia of megakaryocytes was seen in 11/24 and 6/24 showed atypical megakaryocytes with focal clustering in 7/24. Reticulin fibrosis was noted in 7 patients. Iron stores were increased in 13/24 with decreased sideroblasts in 15/24 patients. Review of the 32 patients who had the bone marrow biopsy done for cytopenias showed 16 were hypocellular and 9 were hypercellular while 4 patients had variable cellularity. Mild to moderate megaloblastic change in the erythrocyte series was seen in 12/32 and dyserythropoiesis in 11/32. Granulocytic hypoplasia was seen in 14/32. Benign lymphoid aggregates were noted in 20 patients. Hyperplasia in the megakaryocytes was seen in 8 while 11 had decreased megakaryocytes. Atypical megakaryocytes were noted in 10/32 with clustering seen in 4 patients. Reticulin fibrosis was noted in 13 patients. Iron stores were increased in 16/32 and sideroblasts were decreased in 13/32. Frank hemophagocytosis was observed in 5 patients. Of these 32 patients, 4 were HIV positive. Myelodysplastic syndrome was diagnosed in 2/32, AML and Hemophagocytic lymphohistiocytosis in one each. Conclusions: Bone marrow biopsies are usually performed in patients with Hepatitis C to investigate cytopenias and for diagnosis or staging lymphoma or myeloma. Even without lymphoma involving the marrow, a substantial number of patients have benign lymphocyte infiltrates seen in the marrow. Marrow hypocellularity is common. Megaloblastic change in the erythroid series, dyserythropoiesis, atypical megakaryocytes and reticulin fibrosis can be seen in a substantial minority of the patients which contribute to cytopenias. Disclosures: No relevant conflicts of interest to declare.

Download Full-text

Bone Marrow Findings in Veterans (V) with Hepatitis C Infection (HCV) at a VA Medical Center

Blood ◽

10.1182/blood.v126.23.4632.4632 ◽

2015 ◽

Vol 126 (23) ◽

pp. 4632-4632

Author(s):

Shanthi Srinivas ◽

Katherine Kim ◽

Melanie Gonzalez ◽

Fengming Zhong ◽

Barbara Crump ◽

...

Keyword(s):

Bone Marrow ◽

Hepatitis C ◽

Bone Marrow Biopsy ◽

Hematological Malignancies ◽

Conflicts Of Interest ◽

Public Health Problem ◽

Lytic Lesion ◽

Major Public Health Problem ◽

Bone Marrow Biopsies ◽

Vietnam Era

Abstract Background: Hepatitis C Virus (HCV) is a major public health problem, with an increased prevalence in Veterans. HCV has been associated with B cell Lymphoproliferative disorders and Type II and III Cryoglobulinemias.Prior studies also found that patients with HCV are more likely to develop cytopenias compared normal. Little is known about other possible hematologic manifestations of HCV.We present a series of 54 Veterans seen in a hematology oncology clinic with HCV and their hematologic and bone marrow findings Methods: In an IRB-approved protocol, we reviewed the records of V with HCV who underwent bone marrow biopsy from January 1993 to July 2015. V with hematological malignancies, coinfection with human immunodeficiency virus (HIV), hepatitis A or B, were excluded. Demographics, Vietnam era status, clinical and pathological data, indications for bone marrow biopsies, and results were abstracted. Statistical analysis was performed using SAS 9.4. Results: Of the 54 V, 30 Caucasians, 22 African Americans and 2 Hispanics met the eligibility criteria. 37 served in the Vietnam era. The median (M) age was 59 years (range 39-90). M for WBC 6.9 x109/L (2.9-36.3), hemoglobin 14.3 gm/dL (6.9-19), MCV 93.1 fL (68.8-110..6), platelets 172 x109/L (39-493) , total bilirubin 0.75 mg/dl (0.1-5.3), alkaline phosphatase 96.5 U/L (56-341), albumin 3.9 g/dl (1.6-4.9), lactate dehydrogenase 191 IU/L (91-867), AST U/L (19-426), ALT 56.5.U/L (4-480), INR 1.09 (0.84-2.04). 12 V had splenomegaly by imaging. 10 V at the time of bone marrow biopsy had cirrhosis. The most common indication for bone marrow biopsy was cytopenia (n=38) in at least one of the lineages. The remaining (n=16) were for paraproteinemia, lytic lesion, leukocytosis or lymphocytosis. 48 V had abnormal bone marrow biopsy findings (summarized in Table 1) and 6 V had normal biopsy findings.Table 1.Bone Marrow Findings (n=48)Dysplasia15Hyperplasia14Benign Lymphoid Aggregate4Plasma Cells3Leukemia, Plasma cell dyscrasia4Combination of hyperplasia, lymphoid aggregates or plasma cells8 Conclusions: Veterans with HCV develop cytopenias and hematological malignancies. While Cytopenias can result from splenomegaly, autoimmune mechanism, and medications, some of the cytopenias are unexplained Bone marrow changes from chronic HCV infection may be a contributing factor. Understanding these bone marrow changes from HCV may help in determining the etiology and further management of hematological problems related to HCV Disclosures No relevant conflicts of interest to declare.

Download Full-text

The Certainty of a Post-Bone Marrow Diagnosis: A Study of the Yield of Bone Marrow Biopsies in a Community Hospital Setting

Blood ◽

10.1182/blood-2020-142032 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 34-35

Author(s):

Manasi M. Godbole ◽

Peter A. Kouides

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Bone Marrow Biopsy ◽

Fever Of Unknown Origin ◽

Conflicts Of Interest ◽

Diagnostic Yield ◽

Hospital Setting ◽

Unknown Origin ◽

Nutritional Deficiencies ◽

Bone Marrow Biopsies

Introduction: Most studies on the diagnostic yield of bone marrow biopsy including the one by Hot et al. have focused on the yield of bone marrow biopsies in diagnosing the source of fever of unknown origin. However, there have not been any studies performed to our knowledge looking at overall practice patterns and yield of bone marrow biopsies for diagnoses other than fever of unknown origin. We aim to determine the most common indications for performing bone marrow biopsies in a community-based teaching hospital as well as the yield of the biopsies in patients with specified and unspecified pre-test indications to estimate the rate of uncertain post-test diagnoses. Methods: We performed a retrospective data collection study at Rochester General Hospital, NY. A comprehensive search was conducted in our electronic medical data to identify all patients who underwent bone marrow biopsies over a 5 year period from January 2011 - December 2016 for indications other than fever of unknown origin. Patient data including demographics, pre-bone marrow biopsy diagnosis and post-bone marrow diagnosis was obtained. All patients above the age of 18 who underwent bone marrow biopsy for indications other than fever of unknown origin or follow up treatment of a hematological malignancy were included. Results: A total of 223 biopsies were performed. The median age was 59 years (age range- 23-95). One hundred and sixteen patients were male and 107 were female. The most common indications for performing bone marrow biopsy were evaluation of the following possible conditions: multiple myeloma (n=54), myelodysplastic syndrome [MDS] (n=47), lymphoma (n=28) and leukemia (n=18) as well as non-specific indications such as pancytopenia (n=40), anemia (n=22) and thrombocytopenia (n=11). The proportion of cases confirmed by bone marrow biopsy was 45/54 (83%) with the pre-marrow diagnosis of multiple myeloma, 34/47 cases (72%) with the pre-marrow diagnosis of MDS, 15/18 (83%) with the pre-marrow diagnosis of leukemia and 13/28 (46%) in those with the pre-marrow diagnosis of rule out lymphoma. Thirteen cases (18%) with possible MDS had post-bone marrow diagnoses of leukemia, anemia of chronic disease, myelofibrosis or medication-related changes. Five out of twenty two cases (23%) for anemia and 3/11 cases (27%) for thrombocytopenia without otherwise specified pre-bone marrow etiology had uncertain diagnosis after bone marrow biopsy. Conclusion: In about a fifth of patients necessitating a bone marrow, the diagnosis is discordant and can be surprising. It is also worth reporting that in these discordant results, non-hematological causes such as medications, anemia due to chronic diseases or conditions such as cirrhosis or splenomegaly from other etiologies were among the final diagnoses. Interestingly, 20% of the patients with unspecified pre-bone marrow diagnoses such as anemia or thrombocytopenia in our study had an unclear post-bone marrow diagnosis despite undergoing bone marrow biopsy. Our findings are a reminder that the bone marrow exam does not always lead to a definitive diagnosis and the need by exclusion to include in the differential non-hematological etiologies such as nutritional deficiencies, chronic kidney disease or autoimmune disorders. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Potentially Fatal Neutropenia Associated with the Use of Cocaine Adulterated with Levamisole.

Blood ◽

10.1182/blood.v116.21.3790.3790 ◽

2010 ◽

Vol 116 (21) ◽

pp. 3790-3790

Author(s):

Surbi Shah ◽

Umesh Goswami ◽

Koreth Rachel ◽

David N Williams ◽

Josy Mathew

Keyword(s):

Public Health ◽

Bone Marrow ◽

Conflicts Of Interest ◽

Health Hazard ◽

B Cell Lymphoma ◽

Mass Spectrometry Analysis ◽

Gas Chromatography Mass Spectrometry ◽

Hepatitis C Infection ◽

Bone Marrow Biopsies ◽

The Us

Abstract Abstract 3790 Background: Cases of neutropenia associated with the use of cocaine adulterated with levamisole are being increasingly reported and have become a serious public health hazard. As reported by the US Drug Enforcement Administration (DEA) up to 69% of total cocaine seized in the US is adulterated with this veterinary antihelminthic known to cause agranulocytosis in certain susceptible populations. The rationale for selecting levamisole as an adulterant is unclear, but is likely related to the fact that it shares some physico-chemical properties with cocaine and potentiates the activity of dopaminergic (D2) and NMDA receptors in brain thus enhancing its effects. Methods: A case review was performed of adult patients who presented with neutropenia after the use of levamisole adulterated cocaine. Their laboratory results and treatment outcomes were studied to establish an expected course of the illness. Results: Over a one year period, 5 patients (4 female, 1 male) with age range of 45–60 years, presented with neutropenia in the setting of cocaine use. 4 were positive for levimasole in urine (detected by the use of gas chromatography/mass spectrometry analysis within 4–6 hours of presentation). Bone marrow biopsies were performed in 4 cases showed granulocytic hypoplasia with myeloid maturation arrest, lymphocytic hyperplasia and polytypic plasma cells. Antigranulocyte antibodies (AGA) were positive in 3 of the 4 patients tested. One each had positive serology for serum fluorescent antinuclear antibody (FANA), rheumatoid factor (RF) and antineutrophil cytoplasmic antibody (ANCA). Four of the five patients had hepatitis C infection. One patient had marginal zone B cell lymphoma and another was diagnosed with HIV at her first presentation. The median duration of neutropenia was 5–7 days. 2 patients died as a result of their various co-morbidities. Discussion: Use of cocaine adulterated with levamisole can result in profound neutropenia which could be fatal despite aggressive medical therapy. In patients presenting with neutropenia and a history of substance abuse, a high index of suspicion for cocaine adulterated with levamisole is needed and can be confirmed with rapid testing for both substances in patients' urine. Further diagnostic studies including a bone marrow biopsy with characteristic findings as described above and serologic testing for AGA can aid in confirming the diagnosis and ruling out other common causes of neutropenia. The treatment is usually supportive and based on the Infectious Diseases Society of America (IDSA) guidelines for managing neutropenic patients. The role of public health advisories in providing awareness among patients and care givers cannot be overstated, which can lead to early detection and reduced mortality. Disclosures: No relevant conflicts of interest to declare.

Download Full-text

Treatment of Red Cell Hypoplasia Following Fully Ablative Matched Related Allogeneic Transplant with Stem Cell Boost.

Blood ◽

10.1182/blood.v116.21.4530.4530 ◽

2010 ◽

Vol 116 (21) ◽

pp. 4530-4530

Author(s):

James Essell ◽

Catherine Tierney ◽

Mary Alliston ◽

Edward R. Broun

Keyword(s):

Bone Marrow ◽

Stem Cell ◽

Bone Marrow Biopsy ◽

Conflicts Of Interest ◽

Conditioning Regimen ◽

Blood Type ◽

Red Cell ◽

Allogeneic Transplant ◽

Bone Marrow Biopsies ◽

Post Transplant

Abstract Abstract 4530 We present the case of a 34 year old African American male with T-cell non-Hodgkin's Lymphoma who received a matched related allogeneic transplant using a preparative regimen of cyclophosphamide and TBI from his brother on 11/4/09. The patient's blood type was O+ and the donor's blood type was B+. The cell dose was 10.3 × 106 CD34/kg. His post transplant course was generally uncomplicated. Although he recovered his ANC on D+18 and he was platelet transfusion independent by D+28, he never became red cell transfusion independent. A bone marrow biopsy on day 33 showed no evidence of disease with minimal erythroid recovery. His engraftment studies were all 100% donor cells. His reticulocyte counts are detailed in the table below. On day 126 he had a positive qualitative PCR for parvovirus. He received IVIG (400 mg/kg) for 5 consecutive days beginning 3/15/10. Weekly surveillance for CMV by PCR remained non-detectable. Repeat bone marrow biopsies on day 63 and 88 continued to show neutrophil engraftment, hypoplastic megakaryocytes and aplasia of red cells. His immune suppression was discontinued on day 99. A fourth bone marrow biopsy on day 155 again showed erythroid hypoplasia with neutrophil and megakaryocyte hypoplasia. He received a second infusion of PBSC without a conditioning regimen. He received 2.5 × 106 G-CSF mobilized HPC-A from the original donor on day 205 post transplant. Tacrolimus was reinitiated on day 203. As noted in the table below, his reticulocyte count normalized three weeks post infusion. His last RBC transfusion was given two days prior to the stem cell infusion and he remains transfusion independent today. He continues on tapering doses of tacrolimus and has not experienced any graft versus disease.DateT+WBCHgbPLTANCreticParvo PCR12/7/09336.68.8632.412/9/09356.17.8692.50.68%negative2/25/101131.98.8691.10.10%3/10/101262.18.50.4positive3/25/101423.59.1732.20.10%negative4/1/101492.48.0491.2negative5/25/102032.77.0871.50.10%6/18/10227/233.18.31131.96.10%6/25/10234/303.68.41172.25.20% Disclosures: No relevant conflicts of interest to declare.

Download Full-text

Differential diagnosis of isolated myeloid sarcoma: a case report and review of the literature

Hematology Reports ◽

10.4081/hr.2015.5709 ◽

2015 ◽

Vol 7 (2) ◽

Cited By ~ 12

Author(s):

Patrick A. Hagen ◽

Charanjeet Singh ◽

Melissa Hart ◽

Anne H. Blaes

Keyword(s):

Bone Marrow ◽

Marrow Transplantation ◽

Bone Marrow Involvement ◽

Lymph Node Biopsy ◽

Myeloid Sarcoma ◽

Unrelated Donor ◽

Peripheral Cell ◽

Bone Marrow Biopsies ◽

Cell Counts ◽

Extramedullary Tumor

Myeloid sarcoma (MS) is a rare disease entity identified as a variety of manifestations defined by the occurrence of extramedullary myeloid cell masses with or without bone marrow involvement. This case describes an unusual presentation of isolated MS in a 60-year-old otherwise healthy male, who initially presented to his primary care physician with vague abdominal pain. After extensive workup including three omental biopsies, umbilical core biopsy, and inguinal lymph node biopsy, he was ultimately diagnosed with isolated MS with extensive extramedullary tumor burden. Despite advanced extramedullary disease, peripheral cell counts were normal and bilateral bone marrow biopsies unremarkable with normal cellular lineages, morphology, and cytogenetics. The patient underwent induction chemotherapy and is now greater than 100 days post myeloablative unrelated donor marrow transplantation with no evidence of disease recurrence and 100% donor status with full chimerism. This case demonstrates that making a prompt diagnosis with rapid initiation of treatment in myeloid sarcoma can be challenging due to its varied clinical presentation, cytomorphology, cytochemistry, and cytogenetic overlap with other lymphoid malignancies. Once a diagnosis of MS has been made, moving quickly to induction therapy is important. Several studies have shown that improved overall survival is attained when MS is treated as acute myeloid leukemia and increased survival is noted for patients undergoing bone marrow transplantation. Further prospective studies are needed to elucidate the many remaining questions in regards to the natural history, prognosis, and optimal treatment strategies for this deadly disease.

Download Full-text

Chronic hepatitis C infection in a patient with bone marrow hypoplasia

World Journal of Gastroenterology ◽

10.3748/wjg.14.4238 ◽

2008 ◽

Vol 14 (26) ◽

pp. 4238 ◽

Cited By ~ 2

Author(s):

S Bethlen ◽

K Chandrikakumari ◽

L de Leval ◽

JB Giot ◽

D Mukeba ◽

...

Keyword(s):

Bone Marrow ◽

Chronic Hepatitis ◽

Hepatitis C ◽

Chronic Hepatitis C ◽

Hepatitis C Infection ◽

Bone Marrow Hypoplasia

Download Full-text

The Platelet Millionaire: A Rare Cause of Thrombocytosis in an Adolescent

Blood ◽

10.1182/blood-2019-129278 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 5391-5391

Author(s):

Ritika Walia ◽

Theresa Sepulveda ◽

Sharon Wretzel ◽

Philip H Brandt

Keyword(s):

Bone Marrow ◽

Bone Marrow Biopsy ◽

Primary Care Physicians ◽

Conflicts Of Interest ◽

Abdominal Ultrasound ◽

Cell Transplant ◽

Peripheral Smear ◽

Hematopoietic Stem ◽

Marrow Fibrosis

Objectives: Primary myelofibrosis is rare in pediatrics, often manifesting as persistent idiopathic thrombocytosis.Transitions from pediatric to adult medical care can be complicated by workup requiring invasive procedures. J.M., an 18-year-old healthy male, presented for excessive gingival bleeding after wisdom tooth extraction. Workup revealed persistent thrombocytosis to 1,165K, prompting a referral to hematology-oncology. A peripheral smear was notable for many platelets but normal RBC morphology. He had splenomegaly on abdominal ultrasound and a decreased von-Willebrand's activity to antigen ratio, suggesting acquired vWD. A bone marrow biopsy was advised; however, J.M. became lost to follow up for over 9 months owing to self-reported anxiety about the procedure. He remained asymptomatic in this interim until he re-presented to clinic for easy bruising, with no other evidence of bleeding at the time. The biopsy was pursued, revealing hypercellular marrow for age with left shifted granulocytic and erythroid maturation, abnormal megakaryocytes, and 3% blasts. This was consistent with primary early myelofibrosis (PMF), positive for MF-1, CALR, and TP53 mutations and negative for JAK2 and BCR-ABL. He was transitioned to adult hematology, maintained on baby aspirin, and referred for potential allogeneic hematopoietic stem cell transplant (HSCT). PMF is characterized by marrow fibrosis due to secretion of fibroblast growth factor by clonally proliferative megakaryocytes. It is a disease of adulthood, with 67 years being the median age at diagnosis. Only 100 cases have been reported in children, most of which are secondary to AML, ALL or other malignancies.1 Most patients present with complications of extramedullary hematopoiesis or bleeding.2 Diagnosis is suggested by a leukoerythroblastic picture on peripheral smear and confirmed with a bone marrow biopsy "dry tap" revealing marrow fibrosis.3 Prognosis in pediatric PMF is difficult to predict but outcomes tend to be worse;4 TP53 mutation is rare and based on limited adult studies may portend a poorer prognosis.5 Our young patient with this rare mutation was therefore referred for HSCT evaluation. Further complicating this case was J.M.'s anxiety, which delayed definitive diagnosis by biopsy. He only agreed to it when, at the med-peds clinic, the concept of local pain management was discussed. Anticipation of upcoming procedures by primary care physicians and close follow-up is especially important for patients transitioning from pediatric to adult providers. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Soluble stem cell factor receptor (CD117) and IL-2 receptor alpha chain (CD25) levels in the plasma of patients with mastocytosis: relationships to disease severity and bone marrow pathology

Blood ◽

10.1182/blood.v96.4.1267 ◽

2000 ◽

Vol 96 (4) ◽

pp. 1267-1273 ◽

Cited By ~ 45

Author(s):

Cem Akin ◽

Lawrence B. Schwartz ◽

Takashi Kitoh ◽

Hirokazu Obayashi ◽

Alexandra S. Worobec ◽

...

Keyword(s):

Bone Marrow ◽

Mast Cell ◽

Disease Severity ◽

Bone Marrow Biopsy ◽

Systemic Mastocytosis ◽

Bone Marrow Involvement ◽

Surrogate Markers ◽

Receptor Alpha ◽

Alpha Chain ◽

Receptor Alpha Chain

Abstract Systemic mastocytosis is a disease of mast cell proliferation that may be associated with hematologic disorders. There are no features on examination that allow the diagnosis of systemic disease, and mast cell–derived mediators, which may be elevated in urine or blood, may also be elevated in individuals with severe allergic disorders. Thus, the diagnosis usually depends on results of bone marrow biopsy. To facilitate evaluation, surrogate markers of the extent and severity of the disease are needed. Because of the association of mastocytosis with hematologic disease, plasma levels were measured for soluble KIT (sKIT) and soluble interleukin-2 receptor alpha chain (sCD25), which are known to be cleaved in part from the mast cell surface and are elevated in some hematologic malignancies. Results revealed that levels of both soluble receptors are increased in systemic mastocytosis. Median plasma sKIT concentrations as expressed by AU/mL (1 AU = 1.4 ng/mL) were as follows: controls, 176 (n = 60); urticaria pigmentosa without systemic involvement, 194 (n = 8); systemic indolent mastocytosis, 511 (n = 30); systemic mastocytosis with an associated hematologic disorder, 1320 (n = 7); aggressive mastocytosis, 3390 (n = 3). Plasma sCD25 levels were elevated in systemic mastocytosis; the highest levels were associated with extensive bone marrow involvement. Levels of sKIT correlated with total tryptase levels, sCD25 levels, and bone marrow pathology. These results demonstrate that sKIT and sCD25 are useful surrogate markers of disease severity in patients with mastocytosis and should aid in diagnosis, in the selection of those needing a bone marrow biopsy, and in the documentation of disease progression.

Download Full-text

The significance of bone marrow involvement in non-Hodgkin's lymphoma: the Eastern Cooperative Oncology Group experience.

Journal of Clinical Oncology ◽

10.1200/jco.1986.4.10.1462 ◽

1986 ◽

Vol 4 (10) ◽

pp. 1462-1469 ◽

Cited By ~ 41

Author(s):

J M Bennett ◽

K C Cain ◽

J H Glick ◽

G J Johnson ◽

E Ezdinli ◽

...

Keyword(s):

Bone Marrow ◽

Bone Marrow Biopsy ◽

Hodgkin’S Lymphoma ◽

Bone Marrow Involvement ◽

Eastern Cooperative Oncology Group ◽

Stage Iv ◽

Hodgkin's Lymphoma ◽

Stage Iii ◽

Oncology Group ◽

Non Hodgkin's Lymphoma

Data from four clinical trials conducted by the Eastern Cooperative Oncology Group (ECOG) were used to investigate the importance of bone marrow involvement as a prognostic factor in patients with non-Hodgkin's lymphoma (NHL). A total of 502 patients, 275 with nodular, poorly differentiated lymphocytic lymphoma (NLPD) and 227 with diffuse histiocytic lymphoma (DHL) or diffuse mixed-cell lymphoma (DML), were included in this analysis. Patients were separated into four categories: stage III, stage IV with bone marrow involvement (stage IV-M), stage IV without marrow involvement (stage IV-O), and stage IV with bone marrow and other organ involvement (stage IV-OM). Among the DHL and DML patients, the incidence of marrow involvement was 23%. However, stage IV-M patients had a prognosis that is similar to stage IV-O and stage IV-OM and worse than stage III patients. In contrast, the incidence of involvement with NLPD was 59% and patients with stage IV-M had a survival not different than stage III and not worse than stage IV-O and stage IV-OM. The results suggest that the current emphasis on bone marrow biopsy(s) as a routine diagnostic staging procedure for patients with NHL should be reevaluated. The necessity for this procedure in stage III patients with NLPD is not apparent from our data. One can still justify a bone marrow biopsy in stage I and II patients and can confirm the complete clinical response when all nodes have regressed in more advanced disease.

Download Full-text

The Importance of Bone Marrow Biopsy in the Staging of Patients With Lymphosarcoma

Blood ◽

10.1182/blood.v41.6.913.913 ◽

1973 ◽

Vol 41 (6) ◽

pp. 913-920 ◽

Cited By ~ 13

Author(s):

Vincent Vinciguerra ◽

Richard T. Silver

Keyword(s):

Bone Marrow ◽

Bone Marrow Biopsy ◽

Clinical Stage ◽

Bone Marrow Involvement ◽

Stage Iv ◽

Valuable Procedure ◽

Physical Findings ◽

Positive Results ◽

Extent Of Disease ◽

Initial Staging

Abstract The frequency of bone marrow involvement in patients with lymphosarcoma (LSA) and the particular value of the marrow biopsy, as compared with the aspiration smear technique, in the initial staging of this disease were investigated. Certain physical findings and laboratory studies were analyzed to determine whether the presence of marrow invasion could be predicted. Of 75 patients, 47 (63%) were found to have a positive marrow examination. The clinical stage of 40 of these 75 patients was changed to stage IV as a result of bone marrow biopsy; these included four of nine (44%) stage I patients, 9 of 12 (75%) stage 5 patients, and 27 of 41 (65%) stage III patients. Bone marrow biopsy more often yielded positive results (62%) than did aspiration smears (38%). Little correlation was found between extent of disease on initial physical examination and marrow involvement. A normal hematocrit, white blood cell count, and/or platelet count did not preclude the presence of marrow invasion. The technique of bone marrow biopsy is a simple and valuable procedure in the staging of lymphosarcoma. It uncovers unsuspected and widespread diseases in those patients whose illness appears restricted to even one or two node groups. The high frequency of marrow involvement in patients with LSA is evidence that many patients have widespread disease at the time of diagnosis; thus, marrow biopsy, when positive, is an invaluable test for their initial staging. We urge that it be performed routinely in all patients, irrespective of apparent clinical extent of disease.

Download Full-text