Comments on “Clinical Aspects: Staging and Therapeutic Implications”

Abstract

During this session, the results of pathologic staging in the non-Hodgkin’s lymphomas from several large series were discussed for adults and children. The information obtained from routine multiple bone marrow biopsies and laparoscopy was reviewed. The staging experience of the past 10 years has clarified what new information will be gained from routine sequential bone marrow biopsy, laparoscopy, and laparotomy. The major questions were how to be selective in using the pathologic staging procedures and how the new information gained from the surgical procedures would influence therapeutic programs. It seemed clear that only after 10 years of experience with pathologic staging in Hodgkin’s disease, its precise role and value was being realized. The less satisfactory and more controversial aspects of the classification, staging, and treatment of the non-Hodgkin’s disease will make it more difficult to come to a consensus about the role of pathologic staging in the non-Hodgkin’s lymphomas at this time. The situation seems different for the childhood age group. The reviews by Jaffe, Gout- Lemerle, confirmed by Murphy in the discussion period, conclude that staging laparotomy is rarely of value for children, although diagnostic laparotomy is performed for a significant proportion of the children. Even lymphography is of questionable value in the management of children, in contrast to adults. On the other hand, in multiple myeloma, clinical staging and kinetic data appear to begin to improve results of treatment. The possibility of assessing cell mass before and during treatment through M-component markers open new therapeutic approaches and helps to understand the reason for failures.