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Value of detecting bone marrow involvement in Hodgkin lymphoma

biopsy assessments, and therefore concluded that increased BMU was not due to bone marrow inflammation. However, they did find a correlation between increased BMU and cellularity and concluded that an increased number of haematopoietic cells relative to marrow fat appear to be the main cause of increased BMU. We found a significant correlation between increased BMU and leucocyte/neutrophil count, but, similarly to Adam and Kwee, not lymphocyte count. Therefore, we find it reasonable to assume that the increased leucocyte/neutrophil count could be a result of an inflammatory bone marrow reaction. This would also be in agreement with Adams et al. (2016), if the increased bone marrow cellularity that they observed in the bone marrow biopsies of their patients reflected an increase not only in erythrobut also in granulopoiesis. Unfortunately, they did not report on the cellular basis of the observed increased cellularity. In conclusion, we find it clinically relevant that both uniand multifocal bone lesions should be regarded as suggestive of particularly aggressive disease in cHL and as equally important predictors of adverse outcome, regardless of chemotherapy regimen. We acknowledge that the lack of histological confirmation of bone marrow inflammation/reaction is a limitation in our study, but, in the light of low haemoglobin concentration and increased leucocyte/neutrophil count, we still find it plausible that an increased diffuse BMU may reflect a nonmalignant inflammatory bone marrow environment.