Second Bone Marrow Biopsy?
 

My 90 year old mother was diagnosed with Int I MDS just over 2 years ago. She is still holding her own despite numerous set backs. She has low white & red counts and platelets so we have to be concerned about all three numbers. Current treatment is Aranesp and B12 shots monthly; otherwise palliative care. She is hospitalized every couple of months with some type of infection resulting from her MDS, but she definitely has 9 lives!

My questions are
1. At what point should or does the hematologist perform another BMB? Is there a need? I am just wondering if there is ever a need to do another BMB to determine if there is any progression of her MDS?
2. How do we know if her MDS is progressing to AML? I know that she has about a 30% chance of progression, but didn't know what the signs are. As far as I know, she had <5% blasts in her original BMB two years ago.

Her current numbers are WBC 3.6 (normal is 4.8-10.8); RBC 3.06 (normal is 4.3-5.4), Hemoglobin 9.8 (normal is 12.0-160) and platelets 42 (normal is 130-400). Those numbers have gone up and down a bit over the past 2 years, but in the past 6 months are steadily declining (occasional "up") and we are now at or near her lowest ever on all 4. Her hematologist's biggest concern last month was her low WBC because of her easy risk of infection.

She has several co-morbidities including ILD (interstitial lung disease; she is on oxygen 24/7), hypertension (treated with meds), several bouts of melanoma, osteoarthritis and chronic kidney disease. She is very fatigued, but then she's 90 years old so I don't expect to see her dancing the jig. :)

I think she has already "beat the odds" with her age and illnesses and I am blessed for every minute I have with her. But I just want to be prepared in case they recommend another BMB - is there a reason to put her through that again? Would it improve her quality of life? Thanks for responses.

The hematologist should perform another bone marrow biopsy only if it's needed to determine how to treat her, with the hope of preserving her quality of life. If the current treatment approach will remain the best choice, as opposed to more aggressive drug treatment, no matter what they find in a BMB, then why put her through that? That's the question to put to the doctor if the subject of a BMB comes up.

The same applies to the progression to AML. Will knowing that her classification changed make a different in what you do for her? Perhaps they'll detect signs of AML with peripheral blood tests (e.g., blasts and/or a high white count in the circulating blood) but a bone marrow biopsy may not be needed unless it will produce "actionable" information.

Her counts are low but not extremely low. I suggest that you track her absolute neutrophil count, not just her WBC, to keep a close watch on her risk of infection.

I don't see alot of point in it. her counts are low but not terribly. it sounds like she is doing pretty good at this point. 2 yrs is really good I think at her age.

As long as she is responding to the Aranesp I doubt they would have her do another biopsy. My mother was doing fine on Aranesp (and had been for 2 years) when her numbers dropped this last winter. They doubled the dose which didn't bring up her numbers a lot which is when she got her first blood transfusion. She's been getting double doses since then and tends to need transfusion every 6 weeks. They just decided to do another bone marrow test this month after trying to boost her numbers for almost 6 months. She also had >5% on her last test 2 years ago and her doctor is confident that it hasn't changed but they need to make sure. My mom just turned 79.

Hope that helps!