BONE-MARROW INVOLVEMENT IN HODGKINS-DISEASE - AN ANALYSIS OF 135 CONSECUTIVE CASES

Purpose: To describe the incidence of primary bone marrow involvement (BMI) in Hodgkin's disease (HD) and its correlation with clinical and laboratory features present at diagnosis, and to evaluate the prognost ic relevance of BMI. Patients and Methods: Between 1983 and 1991, 2,30 7 patients with HD were treated according to two trial generations (HD 1-3 and HD4-6) of the German Hodgkin's Lymphoma Study Group (GHSG). Re sults: One hundred thirty-five cases of primary BMI were observed, The incidence of BMI was 4.8% in the HD4-6 study generation, which includ ed all stages. Among stage IV patients, 32% had BMI, Among those with BMI, other organs were also involved in 33%. Among all patients, the p resence of BMI was significantly associated with B symptoms, lymph nod es on both sides of the diaphragm, mixed cellularity histologic subtyp e, leukocytopenia, anemia, thrombocytopenia, lactate dehydrogenase (LD H) level more than 400 U/L, and erythrocyte sedimentation rate (ESR) m ore than 40 mm/h. BMI was negatively correlated with a large mediastin al tumor (3.7% v 20.0% in non BMI cases). Eighty-seven of 108 (81%) as sessable patients with BMI achieved a complete remission (CR). This co mpares favorably with the overall CR rate in all stage IIIB/IV patient s. Among stage IV patients, BMI hers no prognostic relevance with rega rd to freedom from treatment failure and overall survival. Twenty-one patients with BMI relapsed after having achieved a CR. Only five of th ese (24%) again had a positive bone marrow biopsy. Conclusion: The pro gnosis of patients with BMI is not worse than the prognosis of other a dvanced-stage HD patients. BMI alone does not define a special high-ri sk group in which a different treatment approach is indicated.