Is bone marrow biopsy obligatory in all patients with non-Hodgkin's lymphoma?

Bone marrow biopsy (BMB) is recommended as a part of the workup diagnosis in all patients with non-Hodgkin's lymphoma (NHL). This is an invasive procedure that is mostly stressful for the patient and very rarely is associated with severe bleeding. We suggest that the clinician needs to weigh up the potential benefit of this procedure in each case in terms of changing therapeutic approach and prognosis. We think BMB is not mandatory in every patient with NHL and suggest recommendations for which patients we should continue to perform this procedure on.