[Dr. Ken Shain]

Re: Why do bone marrow biopsy?

by Dr. Ken Shain on Thu Aug 14, 2014 10:05 am

Thank you for clarifying. I missed that point. Sorry.

Without seeing the films it is difficult to say with certainty. However, I would state that multiple lytic lesions is consistent with active disease and, as stated in other posts, she would be appropriate for therapy. The CRAB-I criteria (linked to multiple myeloma) are the major barometers for the initiation of therapy. Marrows are not perfect (a small sample of a large marrow), but are important.

I would recommend that one consider a repeat marrow biopsy (on the other side), undergo a PET/CT to assess disease (with multiple focal lesions, I would also be concerned about extra­medullary disease [plasma tumors outside the marrow]), and consider a referral to a myeloma center for another opinion.

If the lesions are not large and she is without other CRAB-I, she is not in immediate danger, but should discuss with her oncologist or see a multiple myeloma specialist sooner rather than later. If already being seen by a multiple myeloma specialist, it may just be his/her opinion that she can be monitored for a time before initiating therapy, delaying therapy for a time. In my clinic, she would be getting therapy with multiple lytic lesions.

Thanks again for clarifying.

CRAB-I = Hypercalcemia, renal failure, anemia, boney lytic disease, and serious infections (in my book).

[Lillyput189]

Re: Why do bone marrow biopsy?

by Lillyput189 on Fri Aug 15, 2014 1:13 am

Thank you Dr Shain!