Published on November 2, 2017
Many myeloma patients dread the painful bone marrow biopsy test and wonder if there are alternative procedures. Experts, Dr. Gareth Morgan and Dr. Brian Walker, discuss the new technology and research surfacing that may offer another pathway to detect abnormalities in blood cells or signs of disease progression. Dr. Faith Davies also shares how myeloma patients can contribute to science by sparing some tissue.
This town meeting is produced by Patient Power in partnership with the UAMS Myeloma Institute. We thank Amgen, Janssen Pharmaceuticals and Takeda Oncology for their support through educational grants.
Transcript | Are There Alternatives to Bone Marrow Biopsy Testing?
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My question has to do with the bone marrow biopsy test, and I probably haven’t had more than anybody else in the room. I understand that might be going by the wayside in the future; that there might be a test on the horizon to substitute for the bone marrow biopsy. Is that right?
I’m going to introduce it a little, and then I’m going to pass it to Brian to answer it properly for you. The answer is we’re in the process of developing those tests, but for the time being the bone marrow is the definitive test. But Brian is already working on blood and imaging approaches to really get us away from doing it. So would you like to comment, Brian?
This is still very much in development, but we are looking at something we call circulating tumor DNA. The tumor cells that are in your bone marrow, some of those are constantly turning over, so some are dying, bursting and releasing their tumor DNA into your bloodstream. And so if we take a peripheral blood sample, we can look to see if we can find any tumor DNA in your blood. These are usually fragmented DNA, so they’re not causing any problems, but the amount of circulating tumor DNA that’s present can be indicative of how many tumor cells are in your bone marrow.
And if we’ve already characterized your bone marrow tumor cells, we can look for the specific mutations or other genetic changes that are characteristic of your tumor cells and see if they’re present in your peripheral blood as well.
So it’s been used as a technique in solid cancers like breast cancer, whereby they can monitor response to treatment. So usually when a patient receives the drug, you have a sharp spike in the amount of circulating tumor DNA as the tumor cells are killed, and then it drops off very rapidly. That dropoff stays very low and begins to creep up again if the cells become resistant to the drug. So you can kind of use this as an early indicator of relapse, as well.
We talked about clinical trials and how important that was and for patients to partake in them. I think as well, many academic centers like ourselves are also doing research alongside the clinical outfit. And the only way we can really make important things like that get to the clinic is for patients to agree to taking part in some of that research. Often I know here, when patients have a bone marrow test we may ask if we can have the spare bit of material that’s left with it to do some research.
And as I say, Brian and his team upstairs here are really looking at the spare bit of bone marrow when patients have that to try and develop these tests so that we can validate and make sure they’re strong before we bring them into the clinic. So if I could just put a plug in there for patients who do want to be involved—it’s not for everybody, I appreciate that—but do want to try and help in some little way, that would be a good way.