A bone marrow biopsy at CLL diagnosis can help determine the need for treatment

This study examined the value of carrying out a bone marrow biopsy before beginning treatment for chronic lymphocytic leukemia (CLL). Researchers reported that a bone marrow biopsy at the time of diagnosis can help determine the need for treatment in CLL patients.

CLL is cancer of the blood and bone marrow. It is one of the most common types of leukemia in adults. CLL is usually diagnosed with blood tests. A biopsy (tissue sample) or aspiration (liquid sample) of the bone marrow is usually not needed to diagnose CLL, but it can help determine the prognosis. The way in which leukemia cells enter the bone marrow (bone marrow infiltration pattern or BMIP) and excessive scar tissue that impairs the bone marrow’s ability to produce normal blood cells (bone marrow reticulin fibrosis or BMRF) can be tested with a bone marrow biopsy. These are markers of how aggressive the disease is. However, more studies are needed to confirm the value of bone marrow biopsies in guiding treatment decisions.

The aim of this study was to examine the role of BMIP and BMRF in guiding treatment decisions for CLL. The records of 65 CLL patients were analyzed. All patients underwent a bone marrow biopsy at diagnosis.

Mild BMRF was observed in 46 patients (70.8%). 11 of these 46 patients (23.9%) required treatment during follow-up. 19 patients (29.2%) showed advanced BMRF. 10 of these 19 patients (52.9%) required treatment during follow-up.

14 patients (21.5%) had diffuse BMIP, which is the pattern of BMIP associated with the poorest prognosis for CLL. 11 of these 14 patients (78.6%) required treatment during follow-up. 51 patients (78.5%) had non-diffuse BMIP. 10 of these 51 patients (19.6%) required treatment during follow-up.

Advanced BMRF and diffuse BMIP were both found to have a significant impact on treatment choice. For patients with diffuse BMIP, the need for treatment was significantly increased 13.1-fold. For patients with advanced BMRF, the need for treatment was increased 2.7-fold. This was not statistically significant.

Researchers concluded that a bone marrow biopsy at the time of CLL diagnosis can help determine the need for treatment.

Larger studies that actively follow patient outcomes are needed to confirm these results.