Volume : 8, Issue : 3, March - 2019

Bone marrow biopsy in Multiple Myeloma: an important diagnostic tool in cases with fibrosis, hypocellular marrow and focal deposits

Roopal Rathi, Tejinder Singh, N Gupta

Abstract :

Introduction: MM is commonest hematologic malignancy of old age. Diagnosis requires demonstration of increased monoclonal plasma cells in bone marrow. We aim to highlight role of BMB in diagnosis of MM. Methods: Bone marrow Biopsy (BMB) and Bone Marrow Aspirate of 50 patients of multiple myeloma were examined thoroughly for different parameters. IHC using CD38, CD138, kappa, lambda antibodies was performed for assessment of tumor load and clonality. Results: Of 8 cases with unsatisfactory bone marrow aspirate (BMA), 4 cases showed significant fiosis. In other 4 cases, marrow cellularity was low (20-30%) and tumor deposit was focal, thus, BMA was inadequate. 8 of 14 cases with focal deposits on BMB couldn’t be picked up on BMA. Monoclonality was demonstrable using CD38, CD138, kappa, lambda. Two cases with non-specific symptoms were diagnosed Smoldering Myeloma on basis of >10% clonal plasma cells on BMB. Conclusion: Bone Marrow Biopsy is particularly useful for diagnosis of MM in cases with low cellularity and marrow fiosis where BMA is inadequate.