Multiple myeloma is a cancer that affects plasma cells, a type of white blood cell found in the bone marrow. These abnormal plasma cells can accumulate and interfere with the production of healthy blood cells, often leading to various health complications. A bone marrow biopsy serves as a diagnostic and monitoring procedure for this condition.
Why a Bone Marrow Biopsy for Multiple Myeloma
A bone marrow biopsy is a procedure that provides direct access to the tumor cells within the bone marrow, which is where multiple myeloma typically grows. This direct examination is highly valuable because myeloma cells are not always evenly distributed throughout the bone marrow, making a direct sample more reliable for assessment. The biopsy helps confirm the presence of multiple myeloma cells and can determine their percentage in the bone marrow, with more than 10% clonal bone marrow plasma cells indicating a diagnosis of multiple myeloma.
The biopsy also plays a role in staging the disease, which helps determine its extent and aggressiveness. Information gathered from the biopsy, including molecular and genetic abnormalities, assists healthcare providers in predicting the disease’s course. Furthermore, bone marrow biopsies are regularly performed to monitor the effectiveness of ongoing treatment and to detect if the cancer has returned or progressed.
Preparing for and Undergoing the Biopsy
Before a bone marrow biopsy, it is important to inform your doctor about all medications and supplements you are taking, especially blood thinners, as these can increase the risk of bleeding. You should also discuss any allergies you have, particularly to anesthetics. While some patients might receive a sedative to help them relax, local anesthesia is administered to numb the biopsy site, which is usually the top ridge of the back of the hip bone.
During the procedure, you will lie on your side or stomach to allow access to the hip bone. After the area is numbed, the procedure involves two main parts.
First, a thin, hollow needle is inserted into the bone to perform a bone marrow aspiration, which draws out a sample of the liquid bone marrow. This may cause a brief, sharp pain or stinging sensation as the liquid is withdrawn.
Immediately following the aspiration, a slightly larger, hollow needle is inserted to obtain a small solid piece of bone marrow tissue, known as the bone marrow biopsy. You may feel pressure as this needle is inserted and a brief pain when the solid sample is taken. The entire procedure, including both the aspiration and biopsy, takes about 10 to 30 minutes.
After the Biopsy and Understanding Your Results
After the bone marrow biopsy, pressure will be applied to the biopsy site to help stop any bleeding, and a bandage will be placed over the area. Advised to keep the bandage dry for at least 24 hours and avoid submerging the site in water until it has healed.
Soreness, bruising, or mild discomfort at the biopsy site may last up to a week, manageable with over-the-counter pain relievers as recommended by your doctor. Recommended to avoid strenuous activities and lifting more than 20 pounds for one to two days to prevent complications.
The collected bone marrow samples are sent to a laboratory for detailed analysis by a pathologist. Pathologists examine the samples under a microscope to identify the number and appearance of plasma cells; a healthy person’s bone marrow contains 2% or fewer plasma cells. Genetic abnormalities in the plasma cells are also assessed, which can provide insights into the disease’s aggressiveness and guide treatment decisions. The time it takes to receive results can vary, ranging from a few days to a week or more, depending on the complexity of the tests. Your healthcare team will communicate these findings and explain how they will inform your treatment plan.
Potential Risks and Side Effects
While a bone marrow biopsy is considered safe, though some side effects and risks exist. Common and mild side effects include soreness, tenderness, and bruising at the biopsy site, which can last for about a week. A hematoma, a large bruise or lump, can also form at the site.
Less common but more serious risks include excessive bleeding, especially for those with low platelet counts or on blood thinners. Infection at the biopsy site is another rare complication, especially for patients with weakened immune systems. Signs of infection include redness, warmth, swelling, or drainage from the site, as well as fever. Allergic reactions to the anesthetic are also possible, though uncommon. Rarely, nerve damage or penetration of the breastbone during a sternal aspiration has been reported. If you experience any excessive bleeding, increased pain, significant swelling, signs of infection, or fever, you should contact your healthcare team immediately.