Results of a series of 104 consecutive bilateral bone marrow biopsy specimens in lymphoproliferative disorders

PURPOSE: To establish the incidence of discordance in a series of bilateral bone marrow biopsies (b-BMB) in lymphoproliferative disorders and to determine whether this might lead to changes in the present treatment of each patient. MATERIAL AND METHODS: Between March/1988 and February/1995, 89 patients underwent bilateral bone marrow biopsy (104 b-BMB). Seventy-six underwent one b-BMB; 11 two b-BMB and 2 patients three b-BMB. Sixty-eight b-BMB were done at diagnosis of the disease and 36 for reassessment prior to ABMT. The distribution of the b-BMB by diagnosis was as follows: 54 non-Hodgkin's lymphoma (NHL) -23 low grade NHL and 31 intermediate/high grade NHL-, 44 Hodgkin's disease (HD), 4 multiple myeloma (MM), 1 splenic lymphoma with villous lymphocytes and 1 MM+HD. Specimens were obtained under local anaesthesia with a Jamshidi gauge 8 needle. The biopsies were fixed, decalcified, embedded in paraffin wax and the section cuts were stained (haematoxylin and eosin, Giemsa, Wilder--reticulin--and Masson--collagen--). RESULTS: There was discordance in 5 of the 104 b-BMB (4.8%), but only in four of them was this related to the presence of bone marrow disease, so that incidence falls to 3.8%. Three of them were obtained at diagnosis of the disease (low grade NHL, high grade NHL and HD) and one during reassessment before ABMT. On considering only the specimens that had bone marrow infiltration (19 cases: 14 at diagnosis and 5 in reassessment before ABMT), the absence of concordance in four of them implies that if only unilateral biopsy had been carried out, up to 21% of the cases might have been missed. In one of these patients (HD) this finding led us to replace autologous bone marrow transplantation by autologous peripheral stem cell transplantation. CONCLUSION: On the basis of these data, the use of bilateral bone marrow biopsy specimens may be justified in lymphoproliferative disorders, both at the time of diagnosis and in reassessment prior to ABMT--when the bone marrow was initially infiltrated.