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Being Proactive With MPNs: Why Aren’t Bone Marrow Biopsies Done More Often?

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Published on April 30, 2019

If you’re able to see progression in myeloproliferative neoplasms (MPNs) with a bone marrow biopsy, why aren’t they done more often? Renowned MPN expert Dr. Srdan Verstovsek, from The University of Texas MD Anderson Cancer Center, joined Patient Power to explain how a healthcare team monitors changes in MPN disease behavior over time. Dr. Verstovsek gives an expert perspective on tests used to measure progression and their recommended frequency. Watch now to learn more.

The Partners series is sponsored by Incyte Corporation. We thank them for their continued support.

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Transcript | Being Proactive With MPNs: Why Aren’t Bone Marrow Biopsies Done More Often?

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.

Nick Napolitano:        

With this particular disease, there’s so much that’s unknown, and me personally, I’ve inquired with several different doctors about bone marrow biopsies, and how often we should do that, and to me, if you’re able to see progression in the bone marrow biopsy, why wouldn’t we do one more often? Why wouldn’t we try and be proactive and take a look at that bone marrow more often, to stay ahead of the progression and be as prepared as possible, right?

Samantha talked about that before we came on, about trying to be prepared, and I have gotten different viewpoints on how often we should do a bone marrow biopsy. I’ve received advice that, “I’m not going to treat you any differently if I see progression,” or, “I’m gonna treat you based on your symptoms.” But to me, that doesn’t compute when we’re trying to be as proactive as possible, and if you can stay ahead of it, possibly, in the bone marrow biopsy, why wouldn’t we do one more often?

Dr. Verstovsek:          

That is an outstanding question, and I cannot tell you how many times I hear about the proactive stance, not perhaps bone marrow biopsies all the time, but proactive. And the sad situation is that the answer that you provided in your comment, is the one that is proper answer. Let’s say that we do bone marrow biopsies in every PV patient every year, and we will find some patients that have more fibrosis than in the past. In fact, 20 percent of PV patients at the time of diagnosis already have some fibrosis. And we know that they are the hardest progression to post in myelofibrosis.

But, the bone marrow biopsy sample is a little bit different form time to time, either the hemopathology’s a little bit different, and you will have to account for these differences and stay put until the next year and make sure that there is real change. And the question is, if you say yes, myelofibrosis is a little bit higher, but otherwise, everything else is the same. I still need phlebotomies, or still have high platelets and whatnot, related to PV. What am I going to be doing differently? And the sad situation is, nothing, really. We don’t have a tool that will be applicable in the patient with PV or ET that has more fibers in the bone marrow than at the beginning. I don’t have a myelofibrosis medication.

I’m not really able to provide the interference that people usually ask about, as opposed to medication to prevent progression, because it hasn’t been proven really to do that. It’s more or less an individual experience within the MPN community that that is a possibility but never documented, so the society, or if you wanna even say insurance companies, or the doctors are not willing to treat people with the medication that has some toxicity and works only for five years usually in patients, because the tolerance is poor long term.

And that is questionable long-term benefit in the prevention of any change, or even reversal of fibrosis. So really, now, and if you do this testing, you would say, “What am I gonna do with these results?” Nothing actionable, and that’s why we don’t really do that. In fact, I would give you the alternative test that I would like to do. Why do the bone marrow biopsies? Why not do the bone marrow testing every six months, on blood? You don’t need to do the bone marrow biopsies to look for fibrosis. You can look at the development of new mutations in a patient’s blood.

That, like in Samantha’s case, would be catching those mutations earlier on, without any invasive procedure. But then, the question will be again, what do I do with these mutations? Now, you have three and you had one, but you are about the same as otherwise, you were, you did not change to myelofibrosis, because you had three mutations versus one, or you didn’t change, if you do the bone marrow biopsies, to myelofibrosis, just because there are more fibers. I highlighted that fact. You have to have other clinical factors that you call it a transformation.

And only when you transform, then you actually do this testing at this time and age, because that is when you can justify the testing, You cannot justify the testing every year for bone marrow even, and the molecule testing. Who’s gonna pay for it, because why are you doing it if there’s—what are you gonna do with this result? And my answer is, unfortunately, nothing, really. I can’t do anything about it. So we do it only when it’s clinically reasonable to do it.

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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