Abstract
e11514 Background: Development of bone marrow carcinosis (BMC) is a rare event in the course of metastatic breast cancer. There are little data regarding its clinical presentation, prognosis, optimal treatment, and associated complications. We analyzed 22 breast cancer patients (pts) with proven BMC diagnosed at our institution between 1995 and 2009. Methods: The data were gathered from pts' charts after approval of the institutional review board. In view of the limited number of cases, a purely descriptive analysis was performed. BMC was assumed in case of histologic or cytologic evidence of diffuse bone marrow infiltration by carcinomatous cells (17 pts) or in case of appearance of erythroblasts in the peripheral blood smear in pts with otherwise unexplained cytopenia (5 pts). Results: All pts presented with osseous metastases at the time of diagnosis of BMC. Anemia was the most prominent hematologic sign present in 77% followed by thrombocytopenia. Cytotoxic treatment was offered to 95% of pts. The majority showed an improvement of their cytopenias following treatment (10 out of 14 anemic pts, 6 out of 9 thrombocytopenic pts, all 4 leukopenic pts). The complication rate was acceptable with only 5 grade 3 or 4 events related to cytopenias (febrile neutropenia, bleeding). Estimated median overall survival from the date of BMC diagnosis was 19 months. After 4 years, 20% of the pts were still alive. Conclusions: We conclude that bone marrow carcinosis in breast cancer has to be considered in particular in pts with bone metastases and otherwise unexplained cytopenia. The peripheral blood smear can serve as a simple diagnostic tool. Cytopenia should not prevent from treating these pts even with aggressive combination regimens, as improvement of marrow function can be achieved in the majority of pts and long lasting survival is possible. No significant financial relationships to disclose.
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