Myelodysplastic Syndrome

What You Should Know About Bone Marrow Biopsy

Cancers that begin in cells of the lymph system are referred to as malignant lymphomas. The lymph system includes the spleen, thymus, tonsils, bone marrow, lymph nodes and circulating white blood cells called lymphocytes. Lymphocytes and the lymph system are part of the immune system that protects the body from disease and infection. Cancers of the lymph system are referred to as Hodgkin’s lymphoma or non-Hodgkin’s lymphoma.

Newly diagnosed lymphoma patients are required to undergo a number of tests and procedures to ensure accurate diagnosis and staging. Tests may include a lymph node biopsy, blood tests, a CT scan, PET scan and bone marrow biopsy. Some patients report that of these, the most difficult is the bone marrow biopsy.

Bone Marrow Biopsy

Bone marrow, found in the center of most large bones, is a spongy material that produces red blood cells, white blood cells and platelets. A bone marrow biopsy is used to evaluate how well the bone marrow is functioning and to determine if MDS is present. In order to obtain a bone marrow sample, the physician must insert a needle through the skin, muscle and outer edge of bone. Although a bone marrow biopsy is typically associated with little pain and only takes about 10 to 20 minutes, many patients do have fear, and anxiety before this procedure.

A bone marrow biopsy is typically performed by inserting a needle into the back of the hip bone. Although not always necessary, some doctors will give their patients intravenous medication for relaxation prior to the procedure. The patient typically lies face down and when comfortable, the skin is cleaned and a local anesthetic is administered to numb the skin and periosteum covering the bone. A hollow, stainless steel needle is then inserted into the back part of the hip bone. First, a sample of the liquid marrow is drawn into the syringe (aspiration). The patient might feel some minor discomfort such as a pulling or drawing feeling down the leg. Next, the physician will take a biopsy from the bone marrow by pressing the needle forward and rotating in both directions in order to break away a small sample. Most physicians use the same needle for both aspiration and biopsy collection. After the aspiration and biopsy, the needle is removed, pressure is applied and a bandage is placed on the biopsy site. Most patients report that after the procedure, the pain immediately diminishes, but they are left with minor discomfort for a few hours. The doctor performing the biopsy may provide specific follow-up instructions, depending on sedation and individual circumstances.

Patients should talk to their doctor before the procedure in order to understand how to manage or minimize any discomfort or anxiety associated with a bone marrow biopsy. If properly performed, a bone marrow biopsy should not cause patients significant pain and should provide useful information for the appropriate management of lymphoma. For more information on a bone marrow biopsy for the staging of lymphoma, talk to your doctor.

Treatment of Myelodysplastic Syndrome

Myelodysplastic syndrome (MDS) is curable and the prognosis is dependent on an age, overall health, and specific genetic or cytogenetic abnormalities.  Treatment is designed to manage the complications associated with ineffective blood cell production, extend survival, and cure the disease when possible.

Treatment of MDS is individualized and depends on:

  1. The severity of low blood counts
  2. The risk of progression to acute myeloid leukemia
  3. Genetic abnormalities detected on cytogenetic analyses

The potential treatment options for MDS include the following:

  • Destruction of abnormal cells through administration of chemotherapy, at either low, conventional, or high doses, depending on the condition of the patient and the aggressiveness of their disease.
  • Supportive care through administration of growth factors to stimulate immature cells to development into mature blood cells.
  • Replacement of damaged bone marrow with healthy cells that develop into blood cells, a procedure called stem cell transplantation
  • Precision medicines or immunotherapies
  • Participation in a clinical trial.

Currently, only stem cell transplant utilizing cells from a donor—called an allogeneic transplant—can consistently cure patients with MDS. Other therapies are directed at prolonging survival and decreasing the symptoms.1,2

References


1 Theo de Witte T, Suciu S, Verhoef G, et al. Intensive chemotherapy followed by allogeneic or autologous stem cell transplantation for patients with myelodysplastic syndromes (MDSs) and acute myeloid leukemia following MDS. Blood. 2001; 98(8):2326-2331.

2 Deeg H, Storer B, Slattery J, et al. Conditioning with targeted busulfan and cyclophosphamide for hemopoietic stem cell transplantation from related and unrelated donors in patients with myelodysplastic syndrome. Blood. 2002;100:

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