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How Often Should MPN Patients Have a Bone Marrow Biopsy?

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Published on September 11, 2015

How often should MPN patients have a bone marrow biopsy? Dr. Brady Stein and Dr. Stephen Oh discuss their views on bone marrow biopsy as it relates to prognosis and treatment.  The experts explain when they recommend a biopsy for patients and the purpose of a biopsy. 

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Robert H. Lurie Comprehensive Cancer Center of Northwestern University

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Transcript | How Often Should MPN Patients Have a Bone Marrow Biopsy?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you’ll get care that's most appropriate for you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Audience:

So in regards to bone marrow biopsies, would you recommend one as a baseline for people who are diagnosed with any of these disorders? And then if you do have one as a baseline from the beginning of your diagnosis, how often do you recommend bone marrow biopsies after?

Dr. Stein:               

So that’s a really, really good question.  And I think I’ll reiterate some of what Stephen was mentioning earlier.  For myelofibrosis, you have to have a bone marrow to make a diagnosis. 

For polycythemia vera, the diagnosis can be made without a bone marrow.  There may be other features.  There may be other standard criteria that can be met, so we can make a formal diagnosis.  And in most cases, for ET nowadays, we do need to do a bone marrow biopsy to establish the diagnosis.  We may have a strong suspicion, but ET can look a lot like very early myelofibrosis.  So if we were to prioritize around the time of diagnosis, I would say that, for ET and myelofibrosis, yes.  For polycythemia vera, I can tell you what we do in our clinic, which may deviate.

But when we are able to make a diagnosis officially based on valid criteria, then we discuss the option of a bone marrow biopsy. We offer it.  Now, when I offer a bone marrow biopsy, of course, that’s not really an offer that many people will take. But what we say is this is not going to change your diagnosis, and it’s not going to change your treatment. 

There may be some information about prognosis.  This may be a useful baseline to compare it to in later years. But we don’t view it as a mandatory thing for polycythemia vera.  We have a discussion about it. And there are patients who approach it very differently.  Certainly, there are patients who want to have one, and there are others who don’t.  so that’s how I approach the baseline.  In terms of the follow-up, we don’t do a follow-up bone marrow, unless we think it’s going to be actionable.  Now, when would we do it? 

If I think the character of your disease is changing, if I think after 15 years of ET or PV, and I’m seeing something different, and I’m suspecting that it’s making its movement or transformation into a new entity, then I need a bone marrow biopsy to make that diagnosis.  So I think if there’s something different about you, your blood or your bone marrow, that becomes an indication.  Also, we look to see how actionable a bone marrow might be.  Am I going to respond to it?  Am I going to change your therapy? Am I going to do anything differently? And we have to ask that, because it’s a procedure. 

Its biggest side effect is discomfort.  It’s what we’re trying to avoid. But if we’re going to go through with it, we’ve got to make sure that it’s actionable.  A clinical trial is a different thing.  So one of the issues with the clinical trial that everyone should be aware of is that, if you’re going to have a clinical trial for myelofibrosis especially, there will be many more frequent bone marrows than otherwise would be done in clinical practice. And that’s, in part, because we may or the company or the scientist may need novel information about how the drug is impacting the bone marrow or special correlates to see how the drug might be working or changing special markers that we couldn’t access otherwise.

So those are some of the caveats.  We don’t do it just to do it routinely. So I wouldn’t recommend that if nothing is changing about you, your symptoms, your blood, I wouldn’t do a yearly bone marrow for any reason.

Dr. Oh: 

One thing I guess I’ll add to that is I generally recommend a bone marrow biopsy before starting any new treatment that could potentially affect the bone marrow.

So hydroxyurea (Hydrea), I wouldn’t do a bone marrow before that.  But if it’s something that at least there’s a possibility that something is going to change, the fibrosis, the marrow, or whatnot, I’d do it. Starting ruxolitinib (Jakafi), most of the time, I recommend doing a bone marrow biopsy to know what it looks like before we start treatment because, even though, for the most part, we don’t think of that treatment as being something that’s going to change the fibrosis to a larger extent. We’re beginning to learn more and more as patients are staying on these drugs for longer periods of time that things might change at least a little bit.

And so in that case, or things like that, I would recommend a bone marrow biopsy before starting the treatment

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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