BMB

[Fant1924]

When is it necessary? Seems that I read that we can get almost everything we need from peripheral blood and that we test to determine whether we are MRD negative. Are there other reasons to test?

—Dennis, 71, Ibrutinib

[PlanetaryKim]

Hi Dennis. If your doctor has reason to suspect you may have myelodysplasia, important to confirm or deny before starting treatment, as chemo not a good choice in that scenario. BMB may be best way to confirm/rule out that possibility. Also, if you have anemia that won't resolve with treatment of the CLL, and that isn't due to AIHA or other cause that can be readily determined, then BMB may provide answers to that.

kim

[Jm954 Administrator]

Hi, In the case of treatment with Ibrutinib, it's not unusual for someone to be MRD negative in the blood but still MRD positive in the bone marrow. The FLAIR trial looks for 2 MRD negative blood samples 6 months apart then asks for a bone marrow to confirm MRD negativity and then potentially the stopping of treatment.

[Hidden]

Hi Fant1924,

I had my third bone marrow biopsy on Monday. The first was at the start of my treatment a year ago and showed 90+% infiltration of white blood cells. The second showed that after six months of Rituxamab and Venetoclax (discontinued) this was down to 70+%. The most recent BMB followed six months of Ibrutinib to see if the WBC infilitration is under 10% and possible remission and to discover why the red blood cells are not reproducing. I have needed regular blood transfusions of erythrocytes to keep up my haemoglobin.

The doctor did say after the second BMB that I had some healthy red blood cells but they were puzzled why they were not recovering. The latest BMB was to find out whether the erythrocytes are still blocked because a) of continuing high infiltration, or b) some underlying auto-immune interference which is attacking the red cells. Three auto-immune possibilities have been suggested for my anaemia - AIHA, myelodysplasia and red cell aplasia. Each of these auto-immune complications have a different blood profile and mine fits best with red cell aplasia.

It seems as though treatment usually begins when the bone marrow is heavily infiltrated and is successful when it has been cleared. I have no CLL in my peripheral blood. I assume, though I am not sure, that the clearing of the bone marrow of excess white blood occurs afterwards. This is how it was in my case, but I don't know if this is generally or always so. Less than 10% is an indication of remission, I believe.

I hope this is useful but I am sure bone marrow biopsies can be used for a much wider range of diagnosis than those limited to my case.

Best wishes, good luck and good health, Peter