Does a patient with newly diagnosed Hodgkin lymphoma need to have a bone marrow biopsy as part of their initial evaluation?

FAQ published on December 26, 2017
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Matthew Matasar, MD
Lymphoma and Adult BMT Services
Director, Lymphoma Survivorship Clinic
Memorial Sloan Kettering Cancer Center
New York, New York
Does a patient with newly diagnosed Hodgkin lymphoma need to have a bone marrow biopsy as part of their initial evaluation?

Welcome to Managing Hodgkin Lymphoma, I'm Dr. Matthew Matasar. One of the questions that I often receive for patients coming to me in consultation is whether or not a patient with newly diagnosed Hodgkin lymphoma needs to have a bone marrow biopsy as part of their initial evaluation. Historically it was very common, if not routine, to perform bone marrow biopsies on patients with a new diagnosis of classical Hodgkin lymphoma regardless of age or stage or symptomatic burden at diagnosis. I think what this led to is a lot of unnecessary or just very low yield biopsies. Currently, the standard of care as defined by NCCN Guidelines as well as recommendations within the RECIL criteria that was published earlier this year is that the majority of patients with Hodgkin lymphoma do not need to have a staging bone marrow biopsy at the time of diagnosis. There are of course exceptions to this. The patients who we do believe benefit from a bone marrow evaluation prior to initiation of first-line therapy are those who have B-symptoms at diagnosis and those who have focal or diffuse uptake in the bone marrow on FDG-PET at baseline. In patients who have neither of these features, who do not have B-symptoms and whose PET scan does not suggest involvement of the bone marrow by lymphoma, a screening/staging bone marrow biopsy is very low yield and does not help guide therapy in a meaningful way.

Last modified: December 22, 2017
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