More aggressive bone marrow screening in retinoblastoma patients is not indicated: The memorial Sloan-Kettering cancer center experience

Abstract

Bone marrow involvement in retinoblastoma patients is rare in the more industrialized nations. The purpose of the current study was to determine the frequency of bone marrow involvement in our series of retinoblastoma patients and to investigate whether the use of four bone marrow aspirates (BMA) and two bone marrow biopsies (BMB) has greater sensitivity for the detection of metastatic disease compared to what has been previously reported. Retrospective analysis of the charts of 54 patients with retinoblastoma was performed. We performed 265 BMA, 134 BMB (4 aspirates and 2 biopsies per evaluation), and 67 lumbar punctures (LPs) in 54 patients with retinoblastoma. There were no patients found with bone marrow or cerebrospinal fluid (CSF) involvement at the time of the initial diagnosis. Although no patient died of distant metastases, two patients developed metastatic disease at recurrence, involving the bone marrow and other sites. For these two patients all four aspirates and two biopsies were positive for disease at the time of recurrence. Despite the use of four BMA and two BMB (as opposed to one bone marrow aspirate that is routinely performed in other centers), the detection of patients with metastatic disease was similar to what has been previously reported. Based on these data more aggressive evaluation of the bone marrow in retinoblastoma patients with clinically limited disease using four aspirates and two biopsies cannot be supported.