Clinical characteristics of patients with metastatic carcinoma in bone marrow in exhaustion phase and the value of emergency chemotherapy combined with best supportive care as a treatment strategy

Abstract

Objective: To study the incidence of metastatic carcinoma in bone marrow (MCBM) in the exhaustion phase and its clinical characteristics, and to explore the value of emergency chemotherapy combined with best supportive care (BSC). Methods: Patients with suspected MCBM in the exhaustion phase were examined by bone marrow puncture and/or biopsy together with PET-CT scans. Nine patients with MCBM received emergency chemotherapy and BSC and the other 6 patients only received BSC. Clinical outcomes, significant history, bone marrow, outcome of routine blood examination, Karnofsky Score (KPS score), complications, remission rate and patient survival were analyzed after treatment. Results: Among 2,876 patients, 15 cases were found with MCBM in the exhaustion phase. These 15 cases had anemia and a history of less than 3 months. They had bone marrow hypoplasia and KPS scores less than 50. Among them, 14 cases had thrombocytopenia and 3 cases had disseminated intravascular coagulation (DIC). For the 9 patients treated with emergency chemotherapy and BSC, the clinical benefit rate was 88.9% (8/9) and the survival was 20 days to 5 years and 7 months. The other 6 patients treated with only BSC had a short survival time (20 days to 3 months). Conclusion: MCBM in the exhaustion phase is rare and the onset is occult. Clinical manifestations are anemia, thrombocytopenia and bone marrow hypoplasia with or without solid tumor history. The diagnosis is difficult. Emergency chemotherapy with reduced dosage in combination with BSC may be of benefit for patients with MCBM in the exhaustion phase and can increase patient survival.