[fishbait]

Bone marrow biopsy interpretation

by fishbait on Mon Oct 03, 2016 12:23 pm

I have been treated with cyclophosphamide, Velcade (bortezomib), and dexamethasone (CyBorD) for more than six months.. I got the following results post-biopsy. I will be speaking with my doctor soon but wondered if someone could help parse this for me.

Thanks.

CLINICAL DATA:

Clinical History: None given.
Clinical Diagnosis: Multiple myeloma

BONE MARROW ASPIRATE REPORT

RESULT:

Differential count:

Cellularity : OK
Megakaryocytes : Present
Blasts : 1%
Promyelocytes : 1%
Myeloid : 51%
Erythroid : 21%
Lymphocytes : 13%
Plasma cells : 13%; including atypical and nucleolated forms
Others : -; Touch prep also examined
M:E ratio : 2.4:1

INTERPRETATION:

Cellular, spicular smears with increased plasma cells (13%), including atypical and nucleolated forms, consistent with involvement by a PLASMA CELL NEOPLASM. Correlation with core biopsy and flow cytometry is recommended.

[Ian]

Re: Bone marrow biopsy interpretation

by Ian on Mon Oct 03, 2016 10:21 pm

Hello Fishbait,

I believe the key result of your biopsy is the plasma cell per­cent­age, which is 13%.

Someone who does not have multiple myeloma has a plasma cell per­cent­age of 3% or 4%. The difference between your 13% plasma cell percentage, and the normal 3% or 4% percentage, is due to the presence of abnormal (myeloma) plasma cells.

So, at this point, your treatment has not gotten the bone marrow plasma cell percentage down to normal levels. Depending on your doctor's treatment philosophy, this could lead to extension of how long you are on your current treatment, or your doctor could choose to change your treatment regimen. It's also possible that the result might not affect what your doctor recommends in terms of what to do next.

Have you and your doctor discussed any targets for your plasma cell percentage? Also, what has happened to your paraprotein level (M-spike) and free light chain levels since you have been on treatment?

I'm not familiar enough with the other biopsy results to comment on them.

Cheers!

[Multibilly]

Re: Bone marrow biopsy interpretation

by Multibilly on Tue Oct 04, 2016 9:17 am

Hi Fishbait,

As usual, Ian is spot on with his comments. It's important to know what your M-spike and free light chain values have been doing over the course of your treatment.

It's also important to know what your bone marrow plasma cell percentage was before you started treatment in order to know whether this figure has improved, deteriorated or remained the same since you started treatment.

[fishbait]

Re: Bone marrow biopsy interpretation

by fishbait on Tue Oct 04, 2016 11:46 pm

Thanks for the responses.

6+ months ago I had 80% plasma cells. now 13%. Additionally, my beta2 microglobulin dropped from 5.7 to 3.0 mg/L. I thought that progress might make me ready for stem cell harvesting, but my kappa free light chains have only come down to 526 mg/L (from 1600 mg/L).

Might that delay the stem cell harvesting, having such a high number of kappa free light chains?

[Multibilly]

Re: Bone marrow biopsy interpretation

by Multibilly on Wed Oct 05, 2016 12:46 pm

I will leave it to others that have been down this path to comment. But I think others that have been down this path will want to first know whether your response has plateaued or whether your numbers are continuing to improve with your current CyBorD regimen.