Bone Marrow Involvement in Hodgkin's Disease: Pathology and Response to MOPP Chemotherapy

Examination of the bone marrow biopsies of 174 patients with Hodgkin’s disease seen at the National Cancer Institute between 1965 and 1972 revealed tumor involvement of the marrow in 19 cases. Eighteen of the 19 patients were treated with intensive combination chemotherapy (MOPP), and 13 achieved complete remission; the median duration of remission was 25+ mo, and 49% of those at risk remained in continuous remission for at least 3 yr. In all patients with marrow involvement, marrow fibrosis due to increased collagen or reticulin was identified in the pretreatment specimen. Repeat biopsies following therapy revealed entirely normal marrow free of tumor and reticulin or collagen fibrosis in eight patients, although residual collagen was detected in three other patients. Pretreatment leukopenia (WBC less than 5000 cells per cu mm) was present in seven of the 18 patients treated with MOPP, and appeared to be associated with an increased risk of infection and a less favorable response to therapy. These results indicate that nonleukopenic patients with Hodgkin’s disease and bone marrow involvement can be safely and effectively treated with intensive chemotherapy, and that pathologic changes in the marrow, including diffuse myelofibrosis, are often reversible with such therapy.