Bone Marrow Biopsy Results

[Jakgal]

Hey everyone! I'm Jak2 positive. I recently got the results of my bone marrow biopsy, and while I was initially diagnosed with ET based on high PLT and Jak2 positive, the biopsy doesn't confirm the ET diagnosis. I have an appointment with my doctor next week and was hoping if any of you can help interpret the results. I really appreciate all of you and I'm so grateful for this platform.

[Jakgal]

bone Marrow Biopsy

Bone Marrow Biopsy

[Jakgal]

bone marrow aspiration

Bone Marrow Aspiration

[Jakgal]

flow Cytometry

Flow Cytometry

[LT55]

I definitely cannot help with the interpretation! What I can share is what my doctor (MPN specialist) told me when I had a BMB last year and saw some concerning/confusing results (thinks like: "not equivocal" and "unclear if pre-fibrotic MF or ET") - comments similar to at least one statement in your BMB results. He told me that the BMB is just one piece of puzzle, and that the patient's symptoms and other factors are taken into consideration to determine if the diagnosis is ET or something else. He told me that nearly all the BMB results have statements that leave room for interpretation.

There are likely others on this forum that will have a different opinion and can read more into these results than I can, but just sharing my two cents. I know I was in a bit of a panic mode in that week between when I saw my results on MyChart and when I was able to talk to my doctor. Good Luck

[Jakgal in reply to LT55]

Hi LT55! Thank you so much for your response. I definitely am in a bit of a panic mode. I hope for the best. I appreciate it!

[EPguy]

Some comments from my experience, but none here are qualified to give any Dx of course.

One item relevant to the ET Dx is Megakaryocytes . In your case "over all normal mature megakaryocyte morphology was dominant" In contrast see my equiv area below:

Mine was: "Megakaryocytes are increased with clustering and hyperlobated forms"

Megakaryocytes are the marrow features that are esp affected by classic ET. Yours are only mildly so, hence the equivocation on the ET Dx.

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Normocellular is good, and reasonable if it were ET. In PV, Hypercellular in the several precursors (to the blood cell types) is common.

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0-1 fibrosity means a very small amount of fibrosity was found, I had the same. This may be seen in ET and PV, while it tends to be higher in MF.

[Jakgal in reply to EPguy]

Hi EPguy! Thank you so much for your response. Your comment has been very helpful clarifying some parts of the report. I appreciate it!

[EPguy in reply to Jakgal]

This is a reference I often suggest to see some Dx criteria. Not all Drs follow all its features, but it is a great guide.

Table 1 in:

ncbi.nlm.nih.gov/pmc/articl...

This is the part about megakaryocytes and ET:

"BM biopsy showing proliferation mainly of the megakaryocyte lineage with increased numbers of enlarged, mature megakaryocytes with hyperlobulated nuclei"

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Your report also noted the type of fibrosis, reticulin had the small positive, collagen was zero. This is the more common result if there is fibrosity, collagen is a more serious type.

"The amount of reticulin fibrosis doesn’t really correlate with the severity of the particular disease. The amount of collagen fibrosis, however, is correlated with the severity of the disease – the more you have, the more severe the disease and the worse the prognosis"

pathologystudent.com/reticu...

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Your BMB report is unusually thorough, they are looking deep.

[Jakgal in reply to EPguy]

Hi EPguy! This is awesome, full of useful information! I appreciate it.🙏

[ainslie]

interpreting BMB results is for expert haems only and even then different experts and pathologists can have slightly different interpretations

[Jakgal in reply to ainslie]

Thank you ainslie!

[SouthSideA]

Greetings Jakgal. I had a similar experience, having originally been diagnosed with PV and then having a bone marrow biopsy that did not support this diagnosis. In my case, the hydroxyurea that I have been on caused many of those markers that would otherwise indicate PV to be muted when I had my biopsy. In my case, as a result of the biopsy, was diagnosed with a “myloproliferative neoplasm - unclassified” while I’m receiving treatment for PV. I hope this helps.

[Jakgal in reply to SouthSideA]

Hi SouthSideA! Thank you so much for your response. I hope to get a clear picture of what I have, if not ET! Your response is certainly helpful. Thank you!

[EPguy in reply to SouthSideA]

Did your Drs say which markers were affected? HU can improve marrow morphology as discussed in some old posts. How durably is not clear.

[TTA_]

Hi!

Given how young you are, and if your ET was caught early, your bone marrow might look normal.

Of course, there are other aspects related to bone marrow morphology to consider, but I find it a bit surprising that the pathologist wrote that the bone marrow morphology does not support a diagnosis of ET, without offering either what else it supports or clearly mention that the bone marrow looks normal for your age.

At age 38 and with then considered essential thrombocythemia with MPL mutation (later reevaluated as hereditary thrombocytosis), my bone marrow morphologically looked normal for my age.

This is the summary of my BMB result:

"The normocellular bone marrow shows complete maturation without significant megakarytocytosis or megakaryocyte morphological alterations. No sign of myelofibrosis. Morphological picture is not characteristic for MPN."

I hope your doctor will do a better job at clarifying what the results of the bone marrow biopsy mean.

[Jakgal in reply to TTA_]

Hi TTA_! Thank you so much for your response. I got confused with that statement too not supporting ET diagnosis and not offering either what else it supports or clearly mention that the bone marrow looks normal for my age. I certainly look forward to my appointment with the MPN specialist. I appreciate your respond🙏