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Bone Marrow Biopsy for the Initial Staging of Patients With Lymphoma: Too Soon to Toss the Trephine

Bone Marrow Biopsy for the Initial Staging of Patients With Lymphoma: Too Soon to Toss the Trephine

Those of us that would prefer avoiding Bone Marrow Biopsies (BMBs) and the pain associated with having the trephine (the surgical instrument used to cut out a bone sample) shoved into our hip, will not be encouraged by what's been reported on the Cancer Networks site.

While CLL (which is both a Leukaemia and a Non-Hodgkin Lymphoma) is not specifically mentioned, the article cites two studies into Hodgkin Lymphoma and diffuse large B-cell lymphoma (DLBCL) and while the much greater sensitivity of PET scans was confirmed, follow-up studies on the patients involved found that there were still advantages of doing a BMB for some patients. (Regular readers will know that having CLL puts us at risk of developing Richter's Syndrome/Transformation, which is a DLBLC).

See more at:

In summary:

Thus, although the prospect is tempting, we do not believe there are sufficient grounds at this time to abandon BMB in patients with lymphoma. BMB still provides robust prognostic information, and in the majority of patients it remains an indispensable staging tool. Many of the published series of PET assessment of bone marrow status are from academic tertiary referral centers with high scan volumes and considerable reporting expertise; the generalizability of their findings remains uncertain. Nevertheless, such sensitive imaging modalities are likely to replace BMB in selected scenarios, such as Hodgkin Lymphoma, once clear and reproducible internationally accepted criteria for positivity are established and validated in community practice settings."

For the moment, it seems that there are still some advantages to doing bone marrow biopsies, but perhaps not for much longer.

Wikipedia covers the biopsy process and includes mention of the recent 'power system' method, which is reportedly faster and easier to use:

For more information on how bone marrow changes as we mature and where the blood forming red marrow is located in adults, Wikipedia covers that here:


4 Replies

Hi Neil

Richter's is a VERY special type of DLBCL... Probably different from both ABC or GBC, but still under investigation.

I have never had a BMB, nor would it have had any bearing on my treatment...

Certainly, there are situation where BMB are usefully and perhaps essential, but in Canada they tend to be done 'as required'.



Did you have a PET scan Chris? I gather they aren't any use in assessing CLL, but I do see mention of them being used to assess DLBLC/Richters, presumably because they are good at identifying rapidly growing cellular masses?


No... my case is different, it is extra nodal, so easily seen on a CT. Basically it is a tumour mass, like a sarcoma etc.. PET is more useful in nodal Richter's, where there may be a number or many nodes involved...

I have had a number of MRIs on my head and spine, to establish the possibility of Central nervous system lymphoma. Thankfully this was not the case, but it did find a spinal bone infiltration and partial collapse of a L2 vertebrae, which initiated radiotherapy on the region...


I have had 2 BMBs (aspiration and trephine in both). Both of these were painless, the first at diagnosis and the second at the screening process for the Imbruvica drug study. I am also donating samples for research and have more BMBs to come over the next 2 - 3 years. I also had a PET scan as the mass on my spine looked like it could have been a high grade lymphoma, fortunately it wasn't :)


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