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Annals of Oncology 2005 16(2):215-218; doi:10.1093/annonc/mdi050
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© 2005 European Society for Medical Oncology

Original article

Can patients with early-stage diffuse large B-cell lymphoma be treated without bone marrow biopsy?

S. T. Lim*, M. Tao, Y. B. Cheung, S. Rajan and B. Mann

Department of Medical Oncology, National Cancer Centre, Singapore

* Correspondence to: Dr S. T. Lim, National Cancer Centre, 11 Hospital Drive, 169610 Singapore. Tel: +65-6436-8172; Fax: +65-6227-2759; Email: dmolst{at}nccs.com.sg

Background: Data on the incidence of bone marrow (BM) involvement in early-stage diffuse large B-cell lymphoma (DLBCL) are lacking. Although BM biopsy is a safe procedure, it is often poorly tolerated. This analysis aims to assess the incidence of BM involvement and to identify parameters predicting BM involvement in early-stage DLBCL.

Patients and methods: One hundred and ninety-two patients with radiological stages 1 and 2 disease were analysed. The data collected were age, sex, presence of B symptoms, white blood cell (WBC) count, platelet count, haemoglobin (Hb), serum lactate dehydrogenase level, serum ß2-microglobulin level, presence of extranodal disease, and the presence of bulky disease (defined as >7 cm).

Results: Overall incidence of BM involvement was 3.6%. Hb < 10 g/dl (P=0.02), WBC count <4 x 109/l (P=0.007) and bulky disease (P=0.06) were found to be predictive of BM involvement. Among the 120 patients without any of these three factors, only one patient had BM involvement (0.83%; 95% confidence interval 0.02% to 4.6%). The absence of all three factors gave a negative predictive value of 99.2%. Overall 3-year survival for patients without all three risk factors was 80%.

Conclusions: BM biopsy may be safely omitted in selected patients with early-stage DLBCL.

Key words: bone marrow biopsy, early-stage DLBCL, incidence, prognostic


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