Would you recommend a bone marrow biopsy to complete staging and would you give G-CSF?

Director, Dana-Farber/Partners at CancerCare Hematology-Medical Oncology Fellowship Program; Senior Physician; Assistant Professor of Medicine at Harvard Medical School in Boston, Massachusetts

This month, Ann LaCasce, MD, weighs in about recommending a bone marrow biopsy and whether or not to give G-CSF.

CLINICAL DILEMMA

A 44-year-old male with no significant past medical history presented after having palpated on himself supraclavicular adenopathy. A biopsy showed Hodgkin lymphoma, nodular sclerosis subtype. A CT showed neck and hilar adenopathy, with a maximum size of 2-3 cm. A PET scan also showed bone disease, as well as supraclavicular, mediastinal, and right hilar adenopathy as described above. Would you recommend a bone marrow biopsy to complete staging? The CBC shows no cytopenias, and the stage is already stage IV disease. I don’t see how it will change the management. Would you give G-CSF? There is conflicting evidence regarding its association with bleomycin toxicity of the lung.

EXPERTS MAKE THE CALL

I agree that a bone marrow biopsy will not change therapy and could easily miss the disease. We don’t give G-CSF unless a patient develops febrile neutropenia or has recurrent infections, in which case we would use as little G-CSF as possible (usually on days 5-8 or 9).

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