The role of bone marrow biopsy in patients with plasma cell disorders: should all patients with a monoclonal protein be biopsied?

M. Hasib Sidiqi, Mohammed Aljama, Shaji K. Kumar, Dragan Jevremovic, Francis K. Buadi, Rahma Warsame, Martha Q. Lacy, David Dingli, Wilson I. Gonsalves, Amie L. Fonder, Miriam A. Hobbs, Yi Lisa Hwa, Prashant Kapoor, Taxiarchis Kourelis, Nelson Leung, Eli Muchtar, John A. Lust, Robert A. Kyle, Ronald S. Go, Vincent S. RajkumarMorie A. Gertz, Angela Dispenzieri

Research output: Contribution to journalArticle

Abstract

We conducted a retrospective review of multiple myeloma (MM), smoldering multiple myeloma (SMM), and monoclonal gammopathy of undetermined significance (MGUS) patients seen at Mayo Clinic to determine whether a bone marrow biopsy (BM) is necessary in all patients diagnosed with a monoclonal protein. A total of 2254 MM, 397 SMM, and 5836 MGUS patients were included in the study. A total of 29 (1.3%) MM patients “without CRAB/FLC” were identified where BM or advanced imaging was critical for diagnosis, 8 (0.3% MM cohort) of whom were diagnosed with MM solely on BM findings (plasma cells > 60%). Without BM or advanced imaging none of these patients would be classified low-risk MGUS. A total of 314 (79%) MGUS-like SMM patients were identified where classification of SMM was based on BM findings. Without BM 97 would be classified as low/low-intermediate-risk MGUS and 151 intermediate or high-risk MGUS; 66 had missing information precluding classification. Only three (<1% SMM cohort) were low-risk MGUS without abnormalities in hemoglobin, calcium, and renal function. In patients presenting with low-risk MGUS and normal hemoglobin, calcium, and renal function, the risk of missing a diagnosis of SMM and MM by omitting BM is <1%. BM should be deferred in these patients in preference to clinical and laboratory monitoring.

Original languageEnglish (US)
Article number52
JournalBlood cancer journal
Volume10
Issue number5
DOIs
StatePublished - May 1 2020

ASJC Scopus subject areas

  • Hematology
  • Oncology

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