Clinical interest of bone marrow aspiration in rheumatology: a practice-based observational study of 257 bone marrow aspirations

Abstract

Bone marrow aspiration (BMA) can be performed by rheumatologists for diagnostic purposes in clinical practice. The aim of the study was to assess professional practices of hospital-based rheumatologists with regard to BMA in order to identify the relevant indications. A retrospective observational study in patients hospitalised in a French university hospital was conducted between 2005 and 2011. All of the patients who had a BMA in the rheumatology department during the study period were included. Clinical indication, number and results of BMA and of bone marrow biopsy (BMB) were collected. Stage and treatment of the haematological disease implemented following the BMA were described. Two hundred fifty-seven BMAs and 79 BMBs were performed during the study period. Of the BMAs, 14.1% were pathological: myeloma (n = 12), malignant B cell non-Hodgkin's lymphoma (n = 6), myelodysplastic syndrome (n = 6), chronic lymphoid leukaemia (n = 4), Waldenstrom's disease (n = 3), chronic myelomonocytic leukaemia (n = 2), hairy cell leukaemia (n = 1) and acute lymphoblastic leukaemia (n = 1). Eight of the 14 pathological BMBs were associated with normal BMA. BMAs were performed equally for gammaglobulin abnormalities (monoclonal peak = 45% of indications, hypogammaglobulinemia = 6%) and for other reasons (haemogram abnormality = 24%, skeletal osteolysis = 6%, unexplained inflammatory syndrome = 5%, lymph node disease = 4% and others). In clinical rheumatology, BMA may reveal two major types of malignant haematological diseases: myeloma with poor prognostic factors justifying polychemotherapy and autologous grafts and, in contrast, slowly evolving B cell lymphoid haemopathies. Given the additional risk in some types of chronic inflammatory rheumatism, BMB should be performed more frequently in certain specific situations (skeletal or lymph node tumour and unexplained inflammatory syndrome).