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Bone Marrow Examination Can Predict Progression Of Multiple Myeloma

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Published: Feb 2, 2011 3:41 pm

A recent European study found that the percentage of plasma cells detected in a bone marrow sample is a strong predictor of multiple myeloma progression following stem cell transplantation.

Although the current definition for complete remission requires less than 5 percent of plasma cells in a bone marrow sample, the study’s authors found that patients with more than 1.5 percent bone marrow plasma cells were more likely to progress. Additionally, there was a trend toward shorter survival in these patients.

The study authors concluded that a bone marrow examination should be one of the first steps in estimating the amount of tumor remaining after stem cell transplantation.

The current criteria for complete remission include negative serum and urine immunofixation tests and less than 5 percent of bone marrow plasma cells. Immunofixation is a laboratory technique that may be used to detect the presence of antibodies produced by myeloma cells.

Although the current criteria are recommended by many of the world’s leading myeloma research groups, some in the myeloma community have suggested that the bone marrow examination is unnecessary for patients with negative immunofixation results. Opponents of the examination argue that the examination is not only uncomfortable for patients, but it is also not a proven prognostic factor for myeloma survival. Additionally, many find the 5 percent limit for bone marrow plasma cells to be arbitrary.

In order to determine the impact of bone marrow plasma cell count on patient long-term survival, physicians from the University of Barcelona, Spain, retrospectively analyzed data from 35 myeloma patients who underwent autologous stem cell transplantation between 1994 and 2008. After high-dose chemotherapy with melphalan (Alkeran), all patients achieved negative immunofixation results and subsequently underwent bone marrow aspiration.

The median percentage of bone marrow plasma cells was 0.8 percent. The study authors acknowledged that their results were uncommonly low. They cited a recent report from the Mayo Clinic in which 14 percent of myeloma patients with negative immunofixation tests had 5 percent or more bone marrow plasma cells. The authors explained that the difference in results might be because the Mayo Clinic study included patients who achieved complete remission after chemotherapy or stem cell transplantation and the Mayo Clinic study included bone marrow biopsies, in addition to aspirates.

After statistically analyzing the data, the authors determined that a cutoff of 1.5 percent bone marrow plasma cells best predicted patient outcomes. Of the 35 patients in the study, 10 patients had more than 1.5 percent plasma cells in the bone marrow. Additionally, the percentage of bone marrow plasma cells after stem cell transplantation was similar regardless of whether patients were initially treated with chemotherapy or novel agents.

After a mean follow-up time of 7.3 years, the median progression-free survival for patients with 1.5 percent or less bone marrow plasma cells was not yet reached, compared to 3.1 years for patients with more than 1.5 percent bone marrow plasma cells.

Median overall survival has not yet been reached in patients with 1.5 percent or less bone marrow plasma cells and is 9.7 years in patients with more than 1.5 percent bone marrow plasma cells. Survival appears to be longer in patients with lower percentages of bone marrow plasma cells, but survival times for the two groups were not statistically different at the time of analysis.

For more information, see the study in the journal Biology of Blood and Marrow Transplantation (abstract).

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  • Lori Puente said:

    What about the fact that bone marrow biopsies can show no MM in one location and 95% in another location. Typically multiple biopsies aren't done in a sitting. Many of us have wondered why so much reliance is given to them when there seem to be "hot spots". Any clarification on that?

  • Carla said:

    My onc said me the same , to not be' warried about result of bone marrow biopsie due to the same reason you are saying, but if the percentage is high even if only in some part , we cannot say that MM is not present.

  • maryann said:

    I was told by one of the doctors that bone marrow transplant is not the way to go. I am concern I was looking forward to completing my 3rd regimen(revlimid 25mg/21/7 plus 40mgdex/eaweek plus zomeda ea/mo 3tx todate no tx since jan/11) and onr doctor stated it may not be beneficial to have the bonr marrow transplantx....? ill ce,,s and invasive a new school of taught was only if pte was non responsive to conventional tx..? please comment

  • Jessica Langholtz (author) said:

    Dear Maryann,

    There are indeed a number of schools of thought regarding the use of stem cell transplants. The first consideration would be your age and whether you are healthy enough to undergo the stem cell transplant procedure. Beyond that, some myeloma specialists recommend that all patients who are healthy enough should undergo a stem cell transplant right away. Others recommend waiting until your first relapse. Others are not in favor of stem cell transplants because there are many myeloma drugs available that are easier to tolerate than a transplant. If you haven't already, you may want to consider getting a second or even third opinion. From there, you can decide which option is best for you.

    Jessica Langholtz

  • Ameer said:

    Hi. My dad is 50 years old n had stem cell transplant 28 march 2012 since then his physically condition is improving dramatically but now after 2 mOnth he only had linalidomide 10mg n Zumeta iv just for one month but imminoficsation is still nOt negative. I just want to ask how lOng does it take for imminoficsation to get negative after autologous transplant. N do u think he might need to undergo another transplant or can achieve handsome lifespan with madication only. Please please reply as I'm very much worried and I'll b great full to u if anyone can mail me on hezalnut@hotmail.com