When is a BMB needed? Earlier this month I visited my Onc. She said that my WBC has increased steadily for 2 yrs from 11 to 73 and that we may need to consider it. Although I was prepared to argue against it, I did not because she did not say specifically that it was time. When my CBC came back slightly lower, 68, the topic went away.

I am not asking about time to treat, just time to conduct BMB. I think we can treat, if needed, without first having a BMB and that we would use BMB to determine treatment effectiveness. Detailed blood work has already validated that I have CLL.

Dennis, ww, 17 p/p53, 68

5 Replies

  • Hi Dennis,

    A BMB is rarely done on diagnosis, may be done during W&W if there's something unexpected happening with your blood counts and quite likely to be done prior to treatment, (to check the degree of infiltration and to determine the markers in your CLL via a FISH/CLL genome test so that you can be given treatment that is most effective for your particular type of CLL). It appears the number of CLL cells in your blood are doubling in under a year - I can't really tell because you've given WBC counts, not lymphocyte counts (ALC - Absolute Lymphocyte Count), which is what your oncologist should be tracking. CLL specialists don't check doubling time until the ALC exceeds 30, which could equate to a WBC of around 40 (it depends on the number of other white blood cells). The good news is that your white cell count - and therefore most likely your lymphocyte count, has stabilised, so you may not hear more about a BMB for many years.

    A doubling lymphocyte count in under a year would not trigger treatment by a CLL expert providing you felt well and had no B-symptoms - it's the least important of reasons to start treatment. If the BMB conversation comes up again, ask if it is preparatory to starting treatment and if the answer is yes, seek a second opinion from a CLL expert or at the very least a haematologist or haematologist-oncologist with regular experience in treating CLL.

    Here are some relevant posts from the Pinned Post section:


  • Thanks Neil. You have helped lots of us. We are lucky to have you at the helm.


  • Amen on that!

  • I'd like to reinforce what Neil shared: The really experienced CLL experts are moving away from using BMBs and CT Scans during Watch & Wait, they only resort to them when the peripheral blood results are really strange and more data is needed to diagnose a complicating problem.

    In clinical trials the drug companies and/or regulatory officials often demand them to track the results, so a baseline may be done just before starting treatment.

    But if your peripheral blood counts and CLL progression is generating results in expected ranges there is minimal additional information to warrant the risks and discomfort.

    As you suggested using a BMB when there are no detectable CLL cells in your blood may be nice to have data point- but even that is not a reliable prognostic marker. So why bother?


  • Thanks Len.

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