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How frequent are bone marrow biopsies?

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I'm at one-year past diagnosis, and just wondering - how often do they tend to perform bone marrow biopsies?  My doctor says he may or may not at the one year mark depending on my PCR levels.  Just wondering what the norms are, and whether biopsies are even needed once you're below 1%.  Thanks!

There's no hard and fast rule. Many doctors are not taking bone marrow biopsies at all, even at diagnosis, and rely on PCR results from peripheral blood.

Some others adhere to older standards which call for one every year, though I think that is increasingly rare now. Some clinical trials will require biopsies at certain intervals.

At about 1% on a PCR test, it's a good bet your are in complete cytoegnic remission - but the way to prove that would be with a bone marrow sample. But let's say it came back with 1 out of 100 cells still carrying the BCR-Abl gene ... would you actually do anything different? Probably not, if your PCR results are still going down so there's really no need when everything else is going well.

David.

Hi there,

Just to add to what David has said it appears that the preference for undertaking a bone marrow biopsy in the early stages of CML treatment is about measuring the cytogenetics and the desire to track the progress of the reduction of the number of Philadelphia chromosomes in the blood and the bone marrow and to assess the rate of decline and the move towards a cytogenetic response.Some have regarded the reduction to 1% or a log 2 reduction as an indication of EMR or early molecular response.I suspect that most of us did not have a biopsy after 1 year,that is if we progressed as expected but it would depend on the specialist physician and his perspective of the situation.There are other considerations as the biopsy is invasive and also more expensive to administer than taking peripheral blood and one normally needs a theatre and a bed for a few hours after the biopsy..Once you start to move towards a molecular response measurements of the level of BCR/ABL gene  in the leukemic cells will be undertaken with the PCR (polychromase) test .As a post script once you reach 0.1 % or log 3 reduction you reach MMR or major molecular response.Beyond log 4 and towards log 5 the PCR -BCR/ABL  test may find it difficult to measure whether there a small or minute number of residual leukemic cells.i believe that beyond 0.1% or log 2 that the biopsy is not so efficient at measuring progress as the use of peripheral blood but I would stand to be corrected.Davids point that some physicians will use the PCR and peripheral blood instead of the use biopsy is interesting and does thsi represent cost issues or has the PCR test become more robust and reliable?

With best wishes

John