Bone Marrow Biopsy May Be Useful in Newly Diagnosed CAD

Marisa Wexler MS avatar

by Marisa Wexler MS |

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A bone marrow biopsy may be useful as a test for an underlying cancer or other conditions involving the excessive immune cell expansion and guiding treatment in people with newly diagnosed cold agglutinin disease (CAD), according to a new study.

The study, “The Role of a Routine Bone Marrow Biopsy in Autoimmune Hemolytic Anemia for the Detection of an Underlying Lymphoproliferative Disorder,” was published in the journal HemaSphere.

CAD is one of several types of autoimmune hemolytic anemia (AIHA) — diseases in which a person’s immune system produces self-reactive antibodies that attack and destroy red blood cells. In some cases of AIHA, the disease is secondary to a lymphoproliferative disorder (LPD) — an immune system condition that causes immune cells to replicate more than they should, such as some types of cancer.

AIHA that is secondary to a LPD generally will not respond to immune-suppressing medications unless the underlying cancer is treated. As such, when a person is newly diagnosed with AIHA, it is recommended they be tested for LPD to guide further care and treatment.

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Testing for LPD often is done via a biopsy of the bone marrow, which is where most immune cells develop. However, there is little data about how useful a bone marrow biopsy is in newly diagnosed AIHA.

Now, scientists in Australia conducted a review of data for patients who underwent a bone marrow biopsy to screen for LPD from 2000 to 2018 at the Princess Alexandra Hospital in Australia.

“Considering the importance of identifying an LPD, many centers, including ours, have performed a routine BM [bone marrow] biopsy. We aimed to examine the diagnostic yield of a routine BM biopsy to diagnose an LPD in patients with newly diagnosed AIHA,” the researchers wrote.

The analysis included 87 patients with AIHA, including 14 who likely had CAD, though researchers noted that this was based on laboratory parameters instead of formal diagnostic criteria, which was a limitation of the study.

LPD was diagnosed in 19 (22%) of the AIHA patients, including six individuals with CAD. Researchers noted that individuals with CAD or mixed disease were markedly more likely to have an underlying LPD. In fact, only one person with warm AIHA had LPD.

“These data suggest the value of routine BM biopsy as part of the initial workup in all AIHA cases is low in the absence of features suggestive of an LPD. Considering a BM biopsy is a low-risk procedure with the potential to reveal an LPD, which has important therapeutic implications, the value of a routine BM biopsy is higher in patients [with CAD or mixed AIHA],” the researchers wrote.

“To our knowledge, our data provide the first systematic assessment of the role of routine BM biopsy in AIHA for the detection of LPD. Our data provide an evidence base for the use of BM biopsy in this context and to support guideline recommendations,” they concluded.