The identification of Hodgkin's disease involving the bone marrow is possible with needle and/or open biopsy techniques. Despite the small fracion of marrow sampled by these techniques, the yield of positive biopsies is 9% in previously untreated patients whose disease is more advanced than Stage II. There is a tendency for marrow involvement to be identified in male, older patients with systemic symptomas and an elevated serum alkaline phosphatase. It is unusual for marrow involvement to result in significant blood count depressions, especially in untreated patients. No involvement of other extranodal sites of disease was identified in nearly one-half of the patients and as such this has important therapeutic implications. The prognostic significance of marrow involvement is not hopeless. Under cyclical combination chemotherapy with nitrogen mustard; vincristine, procarbazine, and prednisone, the actuarial survival at 2 years is 84%, although only 21% of the patients are free of disease 18 months after treatment initiation.

The biopsy proceduresarerecommended for all patients at onset with Stage III extent or greater and is desirable for all patients with systemic symptoms. It is also recommended for all patients who have developed recurrence of disease or symptoms, elevation of the serum alkaline phosphatase, or unexplained blood count depressions after radiotherapy.

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Studies described herein were done in collaboration with Dr. Henry S. Kaplan and were supported by Grants CA-05838 and CA-08122 from the National Cancer Institute, Bethesda, Md. 20014.

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