Journal of Pediatric Hematology/Oncology
RESEARCH ARTICLE: PDF Only
Recommendations for the Use of Routine Bone Marrow Aspiration and Lumbar Punctures in the Follow-up of Patients with Retinoblastoma
Moscinski, Lynn C. M.D; Pendergrass, Thomas W. M.D., M.S.P.H; Weiss, Avery M.D; Hvizdala, Eva M.D; Buckley, Kevin S.; Kalina, Robert E. M.D.
From the Departments of Pathology (L.C.M., K.S.B.) and Pediatrics (E.H.), H. Lee Moffitt Cancer Center and Research Institute, University of South Florida. Tampa. Florida, and Departments of Pediatrics (Division of Pediatric Hematology-Oncology) (T.W.P.) and Ophthalmology (Division of Pediatric Ophthalmology) (A.W.), Children's Hospital and Medical Center. University of Washington, and Department of Ophthalmology (R.L.K.). University of Washington. Seattle. Washington. U.S.A.
Abstract
Purpose: Patients with metastatic retinoblastoma have a poor outcome. Hope that early detection of extraocular spread will improve survival has led to routine monitoring with bone marrow and cerebrospinal fluid (C'SF) examinations. In light of cost and patient morbidity, the clinical utility of this practice is questioned. Patients and Methods: We have performed 254 serial bone marrow aspirations and 164 lumbar punctures in 60 children with retinoblastoma.
Results: Two patients with extensive intraocular disease at diagnosis developed positive bone marrow aspirations, although no patient died of distant metastasis. Three patients developed positive CSF examinations. All had neurologic symptoms at the time of CSF positivity.
Conclusions: We recommend performing staging bone marrow and CSF evaluations only in patients with clinical, histologic, or radiologic evidence of local or systemic extension (Pratt stage III-IV), or in patients presenting with one Reese-Ellsworth group V eye and rctrolaminar or extrascleral extension of their tumor. We recommend limiting follow-up bone marrow and CSF evaluations to patients who develop objective signs and symptoms of metastatic or regionally recurrent disease.