Predictors of Bone Marrow Metastases-Reply

We agree with Stanford et al that there are a number of clinical and laboratory findings that are helpful in predicting which patients with malignancy are more likely to have bone marrow metastasis. The study of Chernow and Wallner¹ identified several such parameters. However, the intent of our study, recently published in the Archives,² was to determine parameters that would identify those patients who are unlikely to have bone marrow metastasis. We reported that patients with small-cell undifferentiated carcinoma of the lung are very unlikely to have bone marrow involvement if they have a negative bone scan and a normal serum lactate dehydrogenase (LDH) concentration, regardless of other clinical and laboratory findings, and that bone marrow examinations in these patients are not routinely warranted. There are several other differences between the two studies that should be noted. The subjects in the report by Chernow and Wallner¹ included