[Gabby]

CT-Guided Needle Aspiration

by Gabby on Sat May 15, 2010 3:05 am

Hi Dr. Hofmeister,

I have a lot of lytic bone lesions. I had four cycles of Velcade, Revlimid and dex followed by transplant. A recent bone marrow of my iliac crest showed no myeloma and on paper I look great yet I continue to be in pain, mostly bone pain. I do take Zometa, but only once every three months. An MRI of my spine showed no collapsed vertebra or compression, although it did show some disc degeneration and some arthritis in my cervical spine. But as my doctor cannot seem to figure out why i am still in pain, he is recommending a CT-guided aspiration of a lesion.

What might be the source of such bone pain, and is such a procedure likely to yield anything of value, in light of the fact that the previous bone marrow sample showed nothing?

Also, he said he's not planning on doing a cytogenetic analysis of the sample, but instead will just "look to see if there's myeloma." If this was your group, would you do a cytogenetic or FISH analysis of the sample (assuming that there was myeloma present)?

Thank you.

[Dr. Craig Hofmeister]

Re: CT-Guided Needle Aspiration

by Dr. Craig Hofmeister on Mon May 17, 2010 5:47 pm

Well yes, anytime I stick a needle into a myeloma patient, we send it for karyotype and FISH -- there is almost no published data to support this practice, but if a biopsy sample shows high risk disease, I want to know.

Constant bony pain in a myeloma patient is not uncommon. Often times it's related to either progressive disease (which apparently you don't have) or fractures (like vertebral compression fractures which commonly cause life long pain despite vertebroplasty). That said there are still patients that have aching where they have had lytic lesions that can persist and that's unfortunate as it requires the patient to be on pain medications and chronic opiates (morphine, oxycodone, etc), NSAIDs, and/or adjuvants (neurontin, cymbalta, etc) all have side effects.

That said if you have a single bone that is causing problem and there's a lytic lesion there, generally this is caused by myeloma and a local problem often is best dealt with by a local treatment, such as directed radiation therapy to that site.