Routine bone marrow examination in the initial evaluation of paediatric Hodgkin lymphoma: the Canadian perspective

Bone marrow examination (BME) in paediatric Hodgkin lymphoma (HL) was evaluated, as evidence from adult HL suggests it may be unnecessary. An internet-based survey was used to examine the practice of Canadian paediatric oncologists regarding BME in children and the impact of routine BME was evaluated in patients with HL treated at our institution. Sixteen of 17 paediatric oncology centres were represented. Forty-three percent of eligible doctors completed the survey. Routine BME for stages III and IV disease was consistent nationally. By contrast, 54% and 70% of respondents reported performing routine BME for stages I and II HL respectively. Respondents were more likely to report performing routine BME in low-stage HL if trained outside Canada (P = 0.04, stage I; P = 0.07, stage II) or practicing at smaller centres (P = 0.05, stage I; P = 0.03, stage II). At our institution, 62 patients were eligible for analysis. Only four patients (6.5%) had a positive BME. Anaemia was the only significant risk factor (P = 0.006). No patient with otherwise low stage was found to have marrow involvement. Comparison of staging with and without BME demonstrated no significant difference to final risk classification. BME in paediatric patients with low-stage HL has extremely low yield and may be unnecessary.