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Bone marrow involvement in Hodgkin's lymphoma: Data from a cancer hospital

Objective: Bone marrow examination is essential for staging Hodgkin's Lymphoma (HL) at the time of diagnosis to determine the correct treatment and prognosis of the disease. The aim of this study was to analyze clinical presentation, hematological profile, biochemical profile, radiological presentation and patterns of bone marrow involvement in patients with Hodgkins lymphoma retrospectively. Materials and Methods: Bone marrow procedures were done in 49 cases of Hodgkins lymphoma a part of staging procedure. Results: 9 patients showed involvement of bone marrow by Hodgkins lymphoma. Clinically, 1 patient was staged as stage II (CSII), 2 patients as stage III (CSIII) and the remaining 6 as stage IV (CSIV) on the basis of extra nodal evidence of disease in liver, bone, lung or pleura on PET scan. The pattern of bone marrow infiltration was diffuse in 3 patients and focal in 6 patients. Length of the biopsy varied from 0.5 cm to 3.0 cm. Conclusion: BME should not be performed in all patients diagnosed with HL as a routine staging procedure. In an already known CS IA, IIA the incidence is very low and in CSIV it provides no additional therapeutic or prognostic information. However, patients with stage IIB, IIIB, IIIA and with any of the following: leucopenia, elevated LDH or ALP levels, splenomegaly should undergo biopsy of adequate length as additional prognostic information may be obtained. If it is suspicious of involvement, serial sections and contralateral biopsies should be examined so that even a single atypical cell or focus is not missed.