Bone Effect of Botezomib in Patients with Relapse and Smoldering Myeloma; A Computer Assisted Image Analysis Study of Bone Marrow Core Biopsies,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3996-3996
Author(s):  
Mohamed E Salama ◽  
Graham E. Wagner ◽  
Tamara Berno ◽  
Jessica Kohan ◽  
Fenghuang Zhan ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Image Analysis ◽  
Bone Marrow Biopsy ◽  
Computer Assisted ◽  
Weekly Dose ◽  
Bone Marrow Biopsies ◽  
Bortezomib Treatment ◽  
Smoldering Myeloma ◽  
Bone Effect

Abstract Abstract 3996 Background: Bone loss and related complications including bone pains, fractures and hypercalcemia are major causes of morbidity and mortality in multiple myeloma (MM) patients. Bone growth/loss (Bone mineral densitometry) can be monitored by dual x-ray absorptiometry (DXA) in patients with smoldering myeloma (SMM). We previously reported a novel quantitative method to asses trabecular volume (TV) using whole scanned slides and image analysis (WSI) obtained from bone marrow biopsy (Teman et al. 2010). This method provides a low cost reproducible mean to assess TV in archival paraffin embedded biopsy materials. Velcade has been shown to produce an anabolic bone effect in relapsed/refractory MM patients and in this study, we examine the effect of low-dose bortezomib (Velcade) in SMM patients using the WSI methodology. Methods: Bone marrow biopsy slides obtained before, during and after bortezomib treatment were used to evaluate TV. H&E stained core biopsy slides were scanned using Scan Scope XT system (Aperio Technologies, Vista, CA) into digital whole slide images that is viewable on Aperio Image Scope. We developed classifier algorithms using Genie (Aperio) pattern recognition image analysis software (PRIA) that were adept at identifying bone, hematopoietic tissue, and clear glass. The calculated bone area (TV) was represented as a ratio of the total hematopoietic area for each biopsy event. Slides were excluded if the analysis available area was less than 6mm2 or could not be classified correctly to the satisfaction of the pathologist Mixed-effects models were used to compare bone TV/hematopoietic ratios (HR) over time and between the different groups, as well as assess any correlation with that ratio and light chain, B-2-microglobulin, and plasma cell levels. Results were considered statistically significant if p<0.05. Results: Slides from 253 consecutive biopsies composed the study materials. 45 were excluded due to significant artifacts or small analysis areas (<6mm2). 208 bone marrow biopsies from 43 patients were included in the analysis. The group included 26 maintenance, 12 relapsed, and 5 smoldering patients; The relapsed and maintenance patients received Bortezomib alone or in combination for a minimum of three cycles; smoldering patients received bortezomib as part of a phase 2 study at the weekly dose of 0.7mg/kg. All maintenance and relapsed, patients had previously received bone marrow transplant with a median 68 years of age 29 were male. Median baseline TV/HR was 32.9%for maintenance 29.8% for relapse and 33.1% smoldering groups. A median increment of TV/RH (17%) was observed after Bortezomib treatment in all groups of patients (p<0.0001). Conclusion: Analysis of bone associated changes after Bortezomib exposure in patients with multiple myeloma by Scan Scope XT demonstrate a post treatment overall gain in bone formation. Monitoring bone indices in patients with multiple myeloma with PRIA may provide a valid tool to assess treatment associated bone effect. Disclosures: No relevant conflicts of interest to declare.

The Certainty of a Post-Bone Marrow Diagnosis: A Study of the Yield of Bone Marrow Biopsies in a Community Hospital Setting

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 34-35
Author(s):  
Manasi M. Godbole ◽  
Peter A. Kouides
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Fever Of Unknown Origin ◽  
Conflicts Of Interest ◽  
Diagnostic Yield ◽  
Hospital Setting ◽  
Unknown Origin ◽  
Nutritional Deficiencies ◽  
Bone Marrow Biopsies

Introduction: Most studies on the diagnostic yield of bone marrow biopsy including the one by Hot et al. have focused on the yield of bone marrow biopsies in diagnosing the source of fever of unknown origin. However, there have not been any studies performed to our knowledge looking at overall practice patterns and yield of bone marrow biopsies for diagnoses other than fever of unknown origin. We aim to determine the most common indications for performing bone marrow biopsies in a community-based teaching hospital as well as the yield of the biopsies in patients with specified and unspecified pre-test indications to estimate the rate of uncertain post-test diagnoses. Methods: We performed a retrospective data collection study at Rochester General Hospital, NY. A comprehensive search was conducted in our electronic medical data to identify all patients who underwent bone marrow biopsies over a 5 year period from January 2011 - December 2016 for indications other than fever of unknown origin. Patient data including demographics, pre-bone marrow biopsy diagnosis and post-bone marrow diagnosis was obtained. All patients above the age of 18 who underwent bone marrow biopsy for indications other than fever of unknown origin or follow up treatment of a hematological malignancy were included. Results: A total of 223 biopsies were performed. The median age was 59 years (age range- 23-95). One hundred and sixteen patients were male and 107 were female. The most common indications for performing bone marrow biopsy were evaluation of the following possible conditions: multiple myeloma (n=54), myelodysplastic syndrome [MDS] (n=47), lymphoma (n=28) and leukemia (n=18) as well as non-specific indications such as pancytopenia (n=40), anemia (n=22) and thrombocytopenia (n=11). The proportion of cases confirmed by bone marrow biopsy was 45/54 (83%) with the pre-marrow diagnosis of multiple myeloma, 34/47 cases (72%) with the pre-marrow diagnosis of MDS, 15/18 (83%) with the pre-marrow diagnosis of leukemia and 13/28 (46%) in those with the pre-marrow diagnosis of rule out lymphoma. Thirteen cases (18%) with possible MDS had post-bone marrow diagnoses of leukemia, anemia of chronic disease, myelofibrosis or medication-related changes. Five out of twenty two cases (23%) for anemia and 3/11 cases (27%) for thrombocytopenia without otherwise specified pre-bone marrow etiology had uncertain diagnosis after bone marrow biopsy. Conclusion: In about a fifth of patients necessitating a bone marrow, the diagnosis is discordant and can be surprising. It is also worth reporting that in these discordant results, non-hematological causes such as medications, anemia due to chronic diseases or conditions such as cirrhosis or splenomegaly from other etiologies were among the final diagnoses. Interestingly, 20% of the patients with unspecified pre-bone marrow diagnoses such as anemia or thrombocytopenia in our study had an unclear post-bone marrow diagnosis despite undergoing bone marrow biopsy. Our findings are a reminder that the bone marrow exam does not always lead to a definitive diagnosis and the need by exclusion to include in the differential non-hematological etiologies such as nutritional deficiencies, chronic kidney disease or autoimmune disorders. Disclosures No relevant conflicts of interest to declare.

Monoclonal Proteins in Elderly Patients with Osteoporosis

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5126-5126
Author(s):  
Kimberley Ambler ◽  
Kevin W. Song ◽  
Larry Dian ◽  
Leslie Zypchen
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Elderly Patients ◽  
Bone Marrow Biopsy ◽  
B Cell Lymphoma ◽  
M Protein ◽  
Bone Marrow Biopsies ◽  
M Proteins ◽  
Osteoporosis Clinic ◽  
Monoclonal Proteins

Abstract Background: Monoclonal proteins (M-proteins) and osteoporosis are both common in the elderly. For most patients with M-proteins and osteoporosis, the protein represents monoclonal gammopathy of undetermined significance (MGUS). In rare cases, the M-protein signifies multiple myeloma, and the osteoporosis is secondary to myeloma bone disease. Thus, it is important to identify M-proteins in patients presenting with osteoporosis, and to consider whether such patients could have myeloma. Objectives: To determine the prevalence of M-proteins in patients age 65 and older referred to the Osteoporosis Clinic at BC Womens’ Hospital in Vancouver, BC, to review the management of patients with M-proteins, and to determine if the characteristics of patients with M-proteins differ from those without M-proteins. Methods: A retrospective chart review of patients age 65 and older referred to the Osteoporosis Clinic at BC Women’s Hospital from April 2006 – March 2008 was performed. Patient demographics, CBC, creatinine, calcium, serum protein electrophoresis, bone marrow biopsy results if available, bone density, presence of osteolytic lesions, fractures, and clinical diagnoses were recorded. Results: 224 charts were reviewed from 205 female and 19 male patients. Osteoporosis was diagnosed in 202 patients. 16 patients (7.1%) had an M-protein. The concentration of the M-protein ranged from &lt;1 g/L to 11 g/L. The characteristics of patients with and without M-proteins are presented in Table 1. Seven patients (3.1%) had background suppression of immunoglobulins with no detectable M-protein. Eight patients (50%) with M-protein had documented vertebral compression fractures compared to 70 patients (38%) with no M-protein. Five patients (31%) with and 41 patients (23%) without M-proteins had other fragility fractures. One patient with an M-protein had a mild anemia. All patients with M-proteins had normal calcium and creatinine. One patient with an M-protein was already known to have a B-cell lymphoma. Two patients were referred to a hematologist. One patient had a bone marrow biopsy and was diagnosed with multiple myeloma. No other patients were thought to have multiple myeloma, but no other bone marrow biopsies were performed. No extra investigations were done in the patients with hypogammaglobulinemia in the absence of an M-protein. Table 1. Characteristics of patients with and without M-proteins. Characteristic No M-Protein (n=201) M-Protein (n=16) Female (%) 184 (91) 14 (88) Age Mean ± SD 74 ± 7.7 77 ± 9.1 Osteoporosis (%) 182 (90) 15 (94) BD Mean ± SD −2.6 ± 1.2 −2.4 ± 1.5 Vertebral # (%) 70 (35) 8 (50) Fragility # (%) 41 (20) 5 (31) Conclusions: M-proteins are more common in elderly patients with osteoporosis than in the general population. Patients with osteoporosis and M-proteins may have an increased risk of fracture compared to such patients without M-proteins. In elderly patients with osteoporosis and M-proteins, it seems likely that the most common plasma cell dyscrasia is MGUS. However, the prevalence of multiple myeloma in these patients is unclear, and a standard approach to investigation is needed. While it is important not to miss a diagnosis of multiple myeloma, it is also prudent to avoid unnecessary invasive procedures (ie. bone marrow biopsies) in elderly and sometimes frail patients.

scholarly journals Increased expression of cyclin-D1 on trephine bone marrow biopsies independently predicts for shorter overall survival in patients with multiple myeloma treated with novel agents

2012 ◽  
Vol 87 (7) ◽  
pp. 734-736 ◽  
Author(s):  
Anna Tasidou ◽  
Maria Roussou ◽  
Evangelos Terpos ◽  
Efstathios Kastritis ◽  
Maria Gkotzamanidou ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Overall Survival ◽  
Cyclin D1 ◽  
Novel Agents ◽  
Bone Marrow Biopsies

Clinical Relevance of Bone Marrow Biopsy in Staging and Follow-Up of Breast Cancer

1983 ◽  
Vol 69 (2) ◽  
pp. 143-150 ◽  
Author(s):  
Giorgio Cruciani ◽  
Gian Maria Fiorentini ◽  
Giovanni Rosti ◽  
Amelia Tienghi ◽  
Daniele Bardella ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Bone Metastases ◽  
Bone Marrow Biopsy ◽  
Clinical Relevance ◽  
Bone Biopsy ◽  
Bone Marrow Biopsies ◽  
Female Patients

Bone marrow biopsies by Jamshidi needle were performed in 106 breast cancer female patients. Sixty-four of them were in follow-up after mastectomy, and neoplastic involvement of marrow was found in 21 patients (32.8%). Among the 42 women undergoing staging before mastectomy, the incidence of marrow involvement was 11.9% (5 women, all with radiographic positivity). Of the 37 women, either in follow-up or in the staging phase, with bone metastases detected by roentgenographic and isotopic examination, the bone biopsy was positive in 23 (62.1%), and 7 histologically had micrometastases. Three women, without any radiographic or isotopic sign of metastases, had positive biopsies. A good correlation was found between the hydroxyproline:creatinine ratio and neoplastic involvement of bone marrow.

scholarly journals Acute Lymphoblastic Leukemia following Lenalidomide Maintenance for Multiple Myeloma: Two Cases with Unexpected Presentation and Good Prognostic Features

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Abdullah M. Khan ◽  
Jameel Muzaffar ◽  
Hermant Murthy ◽  
John R. Wingard ◽  
Jan S. Moreb
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Acute Lymphoblastic Leukemia ◽  
Bone Marrow Biopsy ◽  
Lymphoblastic Leukemia ◽  
Second Primary ◽  
Cell Transplant ◽  
Second Primary Malignancy ◽  
Primary Malignancy ◽  
Prognostic Features

Lenalidomide maintenance following autologous stem cell transplant (ASCT) is considered the standard of care for eligible patients with multiple myeloma (MM). A recent meta-analysis has provided additional evidence that lenalidomide maintenance is associated with a higher incidence of second primary malignancies, including both hematologic and solid malignancies. Acute lymphoblastic leukemia (ALL) as a second primary malignancy is rarely described in the literature. Herein, we describe two patients with MM treated with induction therapy, ASCT, and lenalidomide maintenance that experienced cytopenias while on maintenance. ALL was unexpectedly diagnosed on bone marrow biopsy. One patient was diagnosed on routine biopsy performed as part of requirements of the clinical trial. Both patients had B-cell ALL, without known poor risk cytogenetics, and were managed with standard induction therapies resulting in complete remission. We also reviewed the literature for similar cases of secondary ALL (sALL) in MM patients exposed to immunomodulatory drugs (IMiDs). In conclusion, persistent cytopenias in responding MM patients receiving IMiDs maintenance should be an indication for bone marrow biopsy. Patients develop sALL after median of 32.5 months (range, 20–84) from being on lenalidomide or thalidomide maintenance, often presenting with cytopenias, display low tolerance to chemotherapy, but remission can often be achieved.

scholarly journals Utility of repeating bone marrow biopsy for confirmation of complete response in multiple myeloma

2020 ◽  
Vol 10 (10) ◽  
Author(s):  
Marcella A. Tschautscher ◽  
Dragan Jevremovic ◽  
Francis K. Buadi ◽  
Martha Q. Lacy ◽  
Morie A. Gertz ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Complete Response

Detection of Bone Marrow Involvement in Patients with Cancer

1989 ◽  
Vol 75 (2) ◽  
pp. 90-96 ◽  
Author(s):  
Massimo Federico ◽  
Richard L. Magin ◽  
Harold M. Swartz ◽  
Robert M. Wright ◽  
Vittorio Silingardi
Keyword(s):  
Computed Tomography ◽  
Multiple Myeloma ◽  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Bone Marrow Involvement ◽  
High Sensitivity ◽  
Hematologic Malignancies ◽  
Skeletal Metastases ◽  
Patients With Cancer ◽  
Magnetic Resonance Imaging Mri

Current methods for the study of bone marrow to evaluate possible primary or metastatic cancers are reviewed. Bone marrow biopsy, radionuclide scan, computed tomography and magnetic resonance imaging (MRI) are analyzed with regard to their clinical usefulness at the time of diagnosis and during the course of the disease. Bone marrow biopsy is still the examination of choice not only in hematologic malignancies but also for tumors that metastasize into the marrow. Radionuclide scans are indicated for screening for skeletal metastases, except for those from thyroid carcinoma and multiple myeloma. Computed tomography is useful for cortical bone evaluation. MRI shows a high sensitivity in finding occult sites of disease in the marrow but its use has been restricted by high cost and limited availability. However, the future of MRI in bone marrow evaluation seems assured. MRI is already the method of choice for diagnosis of multiple myeloma, when radiography is negative, and for quantitative evaluation of lymphoma when a crucial therapeutic decision (i.e. bone marrow transplantation) must be made. Finally, methods are being developed that will enhance the sensitivity and specificity of MRI studies of bone marrow.

scholarly journals Atypical sarcoidosis diagnosed by bone marrow biopsy during renal workup for possible multiple myeloma

2012 ◽  
Vol 2 (1) ◽  
pp. 102-106
Author(s):  
Amr El-Husseini ◽  
Alberto J. Sabucedo ◽  
Jorge Lamarche ◽  
Craig Courville ◽  
Alfredo Peguero
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Bone Marrow Biopsy

Bone Marrow Biopsy Needle Design Influences the Bone Content of Recovered Specimens.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5292-5292
Author(s):  
Alec Goldenberg ◽  
Priscilla Kelley ◽  
Cynthia Liu ◽  
Filiz Sen ◽  
Sherif Ibrahim
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Control Group ◽  
Computer Assisted ◽  
Needle Age ◽  
Biopsy Needle ◽  
Operator Experience ◽  
Patients Âgés ◽  
The Mean ◽  
Twin Peak

Abstract Introduction: The integrity and composition of bone marrow core biopsies may be influenced by many parameters including patient age, sex, bone density, operator experience, needle selection and biopsy technique. Biopsy needle design impacts on a needle’s performance and the quality of recovered specimens. We studied the effect of modifying the Snarecoil bone marrow biopsy needle tip on the recovery of trabecular bone in core specimens. Methods: 7 patients, ages 35–92, M/F = 4/3, (2 leukemias, 1 lymphoma, 1 cytopenia, 1 anemia, 2 other) underwent a bone marrow biopsy using a 8 gauge Snarecoil needle with a new needle tip (TPNSP). The tip has a twin peak point and more distal Snarecoil position. As a control group, 7 patients biopsied with a standard 8 gauge Snarecoil needle (NTP) were retrospectively identified and matched for age and sex and were ages 37–87, M/F = 5/2, (3 cytopenias, 2 leukemias, 1 lymphoma, 1 other). All biopsies were completed using a minimally manipulative technique from the left posterior superior iliac spine with 2% lidocaine. The length of the specimen and attached clot was measured. The specimens were decalcified for 90 minutes and otherwise processed in the standard fashion. The percentage of bone per core biopsy was determined with computer-assisted morphometry using a BioGenex iVision V3.5 system. Results: The study and control groups were comparable, as the mean age and M/F distribution of the two groups and the mean lengths of the recovered specimens were not statistically significantly different. (TPNSP vs. NTP, 63.8±7.1 vs. 64.7± 6.4 p=0.93, 4/3 vs.5/2 p= 0.57, 2.32± 0.26cm vs. 2.21± 0.26cm p=0.761, respectively). Needle Age M/F Specimen Length % Bone TPNSP 63.8±7.1 4/3 2.32±0.26 (1.2–3.3) 16.3±1.5 (12.1–21.8) NTP 64.7±6.4 5/2 2.21±0.26 (1.3–2.9) 6.8±1.4 (2.9–12.5) However, the mean percentage of bone in the specimens recovered by the new TPNSP needle was greater than that recovered with the NTP needle. (16.3±1.5% vs. 6.8±1.4%, p= 0.0008). Grossly, the TPNSP specimens had a more linear edge than those of the NTP specimens. Also, more (5/7) of the NTP specimens had > 0.5 cm of attached clot then did the TPNSP specimens (0/7), p=0.005 suggesting that the twin peak needle produced less tissue hemorrhage. Conclusions: 1. 8 gauge Snarecoil needles having a sharper tip and more distal Snarecoil recover specimens with as much as 2.5 fold more bone for histopathologic study. 2. The twin peak needle may produce less tissue hemorrhage and disruption.

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