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Tests > Diagnostic Tests > Bone Marrow Biopsy

Last update: 03/24/2014

  Page Topics
Overview | Overview of Procedure | Reasons for? | About the Fear of Bone Marrow Biopsies | Resources

bonemarrowtransplant_1.jpg (14867 bytes)It's common to be diagnosed with lymphoma with bone marrow involvement. While this might seem alarming, you should know that advanced stages of lymphoma can be treated successfully, and that lymphoma in the bone marrow is as reversible as lymphoma anywhere in the body.

In the News

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FDA Clears Use of Novel Bone Marrow Biopsy System for Oncology http://biz.yahoo.com 

"Necessary for the diagnosis and management of lymphoma, leukemia, myeloma and other hematological disorders, bone marrow biopsy has historically been very painful for patients. The Vidacare system enables the clinician performing the procedure to quickly and precisely enter the intraosseous space, successfully capture a core, with minimal patient discomfort or pain." 

Comment: A less painful test may improve clinical trial participation and utilization of radioimmunotherapy (Bexxar / Zevalin)
  
 
Related Topics:

Lymphoma simplified

What is Bone Marrow Involvement?

 

Overview of the Bone Marrow Biopsy procedure

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Discuss use of blood thinning supplements or medications prior to the procedure. (See sidebar note.)

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Discuss in advance the use of sedatives to relieve anxiety and discomfort. See Questions About Fear of BMB in sidebar.

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The patient is usually placed on the side or lies flat on the stomach.  

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An area above the buttocks near the pelvic bone is anesthetized.  
 
The physician can significantly reduce the discomfort in most cases by taking the time to properly anesthetize the area.
 

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The marrow is recovered from this region using a bone marrow biopsy needle. There are two basic types of samples. Considering the possible discomfort and anxiety associated with bone marrow exams, it's best to get both kinds with each test to avoid having to be stuck twice.
 
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aspirate - liquid from marrow - gets a count of the cells, the cell lines present and and percentages of each. 

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biopsy or core sample - tells about the architecture of the bone marrow, and how the cells may be interacting. "Is there fibrosis? Is there scarring? Is there the presence of different other kinds of diseases or processes going on?" - HealthTalk

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Pressure is applied to the biopsy site to stop bleeding, and a bandage is applied.




Some Reasons for Bone Marrow Biopsies (BMB)

Q&A:  My understanding is that there is no way to tell if there is blood marrow involvement other than a blood marrow biopsy. Should I raise that question with him?

If your blood work is normal it suggests that there is no significant involvement in the bone marrow - which is the nursery for new blood cells.  If cytopenia is found (low blood cell counts) then lymphoma in the marrow could be one explanation and this finding might then be the basis for doing a bone marrow biopsy.  Some degree of bone marrow involvement is common for follicular lymphoma  and can be reversed with treatment.   Our impression is that some oncologists do not give a bone marrow test unless there is a specific reason - such as prior to certain kinds of treatment or if the blood cell counts are trending downward steadily.    Other oncologists may give it routinely as part of staging at diagnosis.   As always, please discuss with your oncologist.

At diagnosis of indolent lymphoma?  Your doctor might recommend a baseline bone marrow biopsy to see if abnormal lymphoma cells are present there and in what percentage.   The findings might help to determine how closely to monitor the lymphoma and perhaps the preferred treatment approach. 

To monitor indolent lymphoma?  Ask your doctor how the findings will influence the timing or approach to treatment - or how you are monitored.  Is it necessary to give now?   

Unusual lab results: Your doctor might order a BMB if unusual or unexpected blood counts or markers are found that indicate disease progression in the marrow or abnormal blood cell generation.

Response to treatment for aggressive lymphoma: A BMB might be indicated in this setting when the goal of treatment is to cure and you have to be able to confirm (as best you can) you've got it all.

Clinical trials: Some (but certainly not all) clinical trials may require a BMB before and after therapy to determine if the treatment has benefit in this region.  

Treatments that require prior BMB: Zevalin and Bexxar require a BMB in advance of the therapy as too much involvement (> 25%) can make you ineligible for this type of treatment.  (Pretreatment with standard therapy might be needed to change your eligibility)

 

Question: Why do you have to have so many bone marrow biopsies? 

A patient informed his doctor that he had a BMB 3-1/2 years ago.  When he asked about having another one, he reported that neither of his two Dr's  thought it was necessary.

 

Question:  Can imaging be used to detect bone marrow involvement - or where to take the sample?

The practice of guiding bone marrow biopsies by imaging is not routine for lymphomas at this time. We are still searching for reports on this question.  

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Magnetic Resonance Imaging of Bone Marrow Versus Bone Marrow Biopsy in Malignant Lymphoma  Abstract
 

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Detection of Lymphoma in Bone Marrow by Whole-Body Positron Emission Tomography - bloodjournal  .pdf 

Ask your doctor to take additional steps to minimize the discomfort, such as taking the time to thoroughly anesthetize the area. 

 It's best to avoid blood thinners prior to having a surgical procedures,  such as  aspirin, fish oil, Vitamin E.

Talk to your doctor about medications and supplements you are taking.


About Fear of Bone Marrow Biopsies
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" I haven’t had one for almost a year. Before that I had had many, maybe 15 or so. They started out easy to take and progressively got worse to take. I am now TERRIFIED of them to the point where I hyperventilate and almost pass out. ...

That day the answers came pouring onto the list (BMT-Talk) from around the world and were still coming four days later. Others were posted privately to the man who had become terrified of bone marrow biopsies. Here are a few:

“Have you tried Versed? The best BMB I ever had was from my local hem/onc, who used Versed—I was kind of awake but felt & remembered nothing.”
 
“I second the vote for the Versed (with a little Demerol thrown in…).”
 
“…IV Diazepam is the intended drug. A short and mercifully deep sedation without actual anesthesia—and usually amnesia about the actual event. You really deserve this after excruciating BMBs.”
 
“Two Vicodans plus Atavin. I can’t say it didn’t hurt but it wasn’t nearly as bad as I thought it would be.”

Source: bmtinfonet.org

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Tony writes:
I'm one of those folks who doesn't like to be awake for his BMB. My first one, just after being diagnosed, was fairly uncomfortable. Okay, it was damn uncomfortable and hurt quite a bit. I had it done at my local hospital. My second one was done at Mayo for the Genitope trial. They put me out for that one to harvest a node, and at the same time did the BMB.

My third BMB was needed for the Favrille trial in Chicago. I was able to get that done at my local hospital but told my doc I refused to have it done without some meds. I got some Vicodin to take an hour or so before the procedure, and I got 2 ml of Ativan by IV just before the procedure. Yeah that was sweet. Didn't feel a thing and did not remember a thing.

BMB number 4 was needed for my current trial. Again wanted some meds. This time just got Versad by IV and it worked great! Didn't feel a thing. Of course it's more involved when you get the meds by IV and you need to have someone to drive you home after. But for me it's worth it.

On the other hand, a few years back my 87 year old mom needed a BMB a few months before she died. I didn't say anything to her about my experience because I didn't want to worry her. After it was over I asked her how bad it was. She said it didn't hurt at all.

So, there's two opposing viewpoints.

~ Tony (Lymphomavaccine support list)

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Resources & Research News

New Bone Marrow Biopsy Needles and Procedures to Minimize Pain? 

"Recently, specimen capturing bone marrow biopsy needles have been introduced to minimize the pain resulting from manipulations of the bone marrow needle and to help your doctor ensure recovery of adequate specimens.
 
The SNARECOIL TM bone marrow biopsy needle is a specimen capturing needle that incorporates a tiny internal snare mechanism that coils around the tip of the specimen after it has entered the needle and thereby captures it. 
 
This mechanism eliminates the need to significantly move the needle after it has been advanced into the bone marrow tissue to sever and recover the specimen. This advantage is relevant not only for the patient who may require a single bone marrow biopsy for diagnosis but especially for those patients with hematologic malignancies such as leukemias or lymphomas who may require multiple procedures to evaluate the efficacy of their treatments."  - ranfac.com

NOTE: We are seeking to verify the claims made above. 

 

 

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About bone marrow biopsies  Cancer Help OrgMedline Plus  
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Utility of fine-needle aspiration (FNA) as a diagnostic technique in lymphoma. J Clin Oncol. 2004 Aug 1;22(15):3046-52. PMID: 15284254 

"Conclusion Overall, FNA for lymphoma diagnosis is not helpful, not cost effective, and in addition may misguide treatment."
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BCL-2/ t(14;18) Gene Rearrangement, Quantitative Real-Time PCR   Questdiagnostics 

"The t(14;18) translocation is characteristic of B-cell lymphomas, occurring in up to 90% of follicular lymphomas. It is also found in 20% to 30% of diffuse large B-cell lymphomas ..."

PCR has an analytical sensitivity of 1 tumor cell in 100,000 normal cells.

What is PCR  Testing?  faseb.orgm
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Randomized, placebo-controlled study of outpatient premedication for bone marrow biopsy in adults with lymphoma. Clin Lymphoma. 2000 Sep;1(2):154-7. PMID: 11707825 abstract
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The significance of bone marrow involvement in non-Hodgkin's lymphoma: the Eastern Cooperative Oncology Group experience. J Clin Oncol. 1986 Oct;4(10):1462-9. PMID: 3531421  PubMed
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Bone marrow biopsy for the staging of non-Hodgkin's lymphoma: bilateral or unilateral trephine biopsy? Tumori. 1995 Nov-Dec;81(6):410-3. PMID: 8804465  PubMed
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Imaging to detect bone marrow involvement?

Comparative diagnostic accuracy of magnetic resonance imaging [MRI] and immunoscintigraphy  (An imaging procedure in which antibodies labeled with radioactive substances are given to the person.  A picture is taken of sites in the body where the antibody localizes.) for detection of bone marrow involvement in patients with malignant lymphoma. 
J Clin Oncol. 1997 May;15(5):1754-60. PMID: 9164182
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Bone marrow biopsy for the staging of non-Hodgkin's lymphoma: bilateral or unilateral trephine biopsy? Tumori. 1995 Nov-Dec;81(6):410-3. PMID: 8804465 | Related articles
 
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professional medical advice or to replace your relationship with a physician.
For all medical concerns,  you should always consult your doctor. 
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