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Are Bone Marrow Biopsies Necessary in Treating NHL?

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Published on June 16, 2020

Currently, bone marrow biopsies are performed before and after treatment in patients with follicular lymphoma in clinical trials. Patient Power Co-Founder Esther Schorr speaks with Dr. Sarah Rutherford, Weill Cornell, about her work in follicular lymphoma and the research that questions the necessity of bone marrow biopsies to confirm response to treatment.

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Transcript | Are Bone Marrow Biopsies Necessary in Treating NHL?

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.

Dr. Rutherford:

My ultimate goal is to try to remove bone marrow biopsies as requirements for clinical trials. And this really comes back to the patient focus. My dad was actually diagnosed with Hodgkin lymphoma when I was a medical student and has done well, was cured of that disease. And as I've gone along in training and as a physician in practice, here in New York, I really I thought about what it's like for the patient and how they must feel throughout this process. So I would really like to remove unnecessary procedures from their workup and treatment course.

There are certain instances where they're very important to do, if it's going to make a difference in terms of our diagnosis or treatment plan. And we have a lot of experience and a way to make people comfortable in them. But certainly if we don't need to do a procedure, we would like to avoid it.

This study particularly looked at follicular lymphoma, but I'm actually hoping to apply this to other types of lymphomas as well. And in this study, we looked at patients who had undergone treatment on clinical trials, through the cooperative groups. So the Alliance for Clinical Trials and SWOG, we've also done some work with ECOG and we looked at a large number of patients and showed that very few of bone marrow biopsies made an impact on their response assessment. That's the main reason why we do bone marrow biopsies in clinical trials.

Just to elaborate a little bit, when someone has a complete response on their imaging test, which is either usually a pet scan or a CT scan, most clinical trials require that the patient then undergoes a bone marrow biopsy, which they would have already undergone at the beginning of the trial, to confirm that there's no lymphoma there in the bone marrow.

So essentially, we showed that there are very few patients who the bone marrow biopsy made a difference in their response assessment, and therefore we're advocating for removing them from requirements for follicular lymphoma trials. I actually, just last month, had published a study along with a group from the GOYA and GALLIUM studies, which were large follicular lymphoma and diffuse large B cell lymphomas. I said that in reverse order. But, we also looked at bone marrow biopsies and those patient populations and found similar results. So keep posted for more studies on this. But again, this is part of a broader effort to try to eliminate any unnecessary testing from clinical trials to really focus more on the patient.

We’re actually advocating to take them out altogether. Because the only patients who actually need to have repeat bone marrow biopsies are the ones who have involvement of the lymphoma at the beginning. And then essentially if they have a complete response on their imaging, we have to make sure based on current clinical trial requirements that the bone marrow has been cleared of the lymphoma. So the point is, that there's very few patients that fall into that category and therefore we would like to eliminate them entirely from the beginning and any subsequent time during clinical trials.

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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