CLL Support Association
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At what point should a bone marrow and lymph node biopsy be done

I am Canadian being treated in London, Ontario. I was diagnosed with SLL in early 2015 with an enlarged spleen and lymph node (but not sure how long it was pre-existing). It became CLL in late 2015. My white blood count was at 16 in Oct. 2016 and now at 15 lately. I have all the CLL symptoms on a daily basis including swelling, pain in the neck and fever. My oncologist does not recommend a biopsy at this time. My concern: at what point should the biopsy be done?

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A biopsy really doesn't need to be done prior to treatment unless your SLL/CLL is showing some unusual behaviour, in which case your specialist may decide to do one to try and identify the cause.

You say you are being treated - so your treatment type will influence whether (and if so when) a bone marrow biopsy is required, e.g. as one of the requirements for a clinical trial. If you aren't on a clinical trial then there's probably no need for a biopsy until after your treatment is completed (if chemo based treatment). Your specialist might then arrange for one to check your Minimal Residual Disease status.


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When my white blood count went up. My Oncologist did bone marrow and lymph node biopsies to diagnose my CLL. He may have had his opinion as to what I had but to be sure he had ordered the biopsy's to determine exactly what was in my bone marrow and lymph nodes.


I am also in Ontario and I was diagnosed with CLL in 2011. At that time I was told the cancer is slow growing and I should have at least 10 years before treatment is required. I was put on W&W and my fatigue got worse each month. In early 2013 I ended up in emergency at which time it was decided a bone marrow biopsy was required. The results came in and I was told that I was special and the cancer [72%] was hiding in my bone marrow. They started FCR the following week and they had to stop after four rounds due to the depletion of my red blood cells. At this time they said I have 3 to 4 years before the CLL comes back. I am happy to report that they were wrong and all my numbers are in range.


BMB aren't done routinely in Ontario, they are done if there is a reason. Our treatment protocols are a bit different than the U.S.

I suggest you head down to Juravinski CC and get a second opinion, they are a CLL center of excellence with very informed CLL doctors...

Studies show that patients under the care of CLL specialist at a CLL research center, have a better clinical course and live longer than patients in community oncology care.



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