Abstract
Bone marrow (BM) metastases are known to worsen the outcome in patients with malignancies and alter the choice of the treatment regimen. In an attempt to identify routine parameters for the prediction of BM metastasis we evaluated the clinical and laboratory data of 103 patients with metastatic solid tumors. We also assessed which of these factors appeared to influence survival. Three laboratory abnormalities were found to be predictive of metastasis on BM biopsy: thrombocytopenia < 50 × 109/L OR 14.4; p = 0.02; hypocellular or dry tap aspirate OR 7.0; p = 0.02 and high serum alkaline phosphatase OR 6.5; p = 0.03. Three additional factors were found to be associated with deceased survival. Thrombocytopenia was associated with decreased survival from a median of 0.8 months to 4.1 months, p < 0.0001. Serum LDH levels more than twice the upper limit of normal were also reduced survival from 1.8 months versus 4.7 months, p = 0.03. Finally, the initial diagnosis of malignancy by bone marrow examination was associated with reduced survival from 1.8 months vs. 4.0 months, p = 0.03 in individuals where BM metastases were not the presenting feature of malignancies. Use of these simple clinical parameters may help in the early diagnosis of bone marrow metastases and improve clinical approach.
Highlights
Bone marrow (BM) metastases are diagnosed in 0.2% - 12% patients with solid malignancies
Predominantly thrombocytopenia, was the most common indication for marrow examination in 44 (61%) patients with BM metastasis, followed by bone lesions in 17 cases (38%) lymphadenopathy in 8 patients (11%), unexplained fever and hypercalcemia in 3 (4%) individuals respectively
Patients with BM metastases have very poor prognosis, those individuals in which the initial diagnosis of malignancy was established on the bone biopsy
Summary
Bone marrow (BM) metastases are diagnosed in 0.2% - 12% patients with solid malignancies. The recent introduction of novel diagnostic methods for detection of disseminated tumor cells (DTC) such as reverse-transcriptase polymerase reaction (RT-PCR), fluorescent in situ hybridization (FISH), flow cytometry, and native or cultured bone marrow cells has greatly increased the likely detection of BM metastases [8] [9] [10] [11]. These techniques are not yet routinely applied or standardized. The prognostic impact of low-burden BM metastatic spread is still controversial [8] [12] and their effect on the therapeutic approach remains unclear [13]
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