Last update: 04/26/2008

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The bone marrow is a soft tissue that is inside some of the larger bones. It contains stem cells which develop into the three different types of blood cell: red blood cells white blood cells, and platelets.   

It's common to be diagnosed with lymphoma at an advanced stage (III or IV) and with bone marrow involvement. While this might seem alarming, you should know that advanced stages of lymphoma can be treated successfully, and that lymphoma in the bone marrow is as reversible as lymphoma anywhere in the body.  

One way to understand this is to compare lymphoma with a so-called solid tumor, such as a prostate cancer.  Here the cell of origin of the cancer does not normally exist anywhere but in the prostate.  So when you find malignant prostate cells in the bone marrow, you have a serious problem.  Compare with blood cells that we expect to move anywhere in the lymphatic or circulatory system, including the "nursery" for these cells, the bone marrow.

Bone marrow involvement and survival for low grade NHL?  PubMed | Related articles "Conclusion. The presence of bone marrow infiltration at diagnosis did not significantly affect the  prognosis of low grade non-Hodgkin's Lymphoma (LGNHL)."

A diagnosis of lymphoma in the bone marrow can only be established by obtaining a bone marrow specimen for analysis - a bone marrow biopsy. This test might be done for staging purposes in order to provide a baseline of where the lymphoma is so that it can be monitored for progression, guide treatment, and judge response to subsequent treatment.  (Also see Some Reasons for a Bone Marrow Biopsy.)

Is a negative [for lymphoma] bone marrow finding conclusive? 

A negative bone marrow result means that there's an improved chance that the marrow is clean or relatively clean, but it's not a conclusive result. Here's an analogy: Take a bucket of water out of a swimming pool at night. If no leaves are in the bucket you can't conclude the pool is without leaves - only that the sample has no leaves.  

Improving the sampling process

Imaging such as MRI or PET can "help increase the positive yield of bone marrow biopsies by guiding the marrow sampling procedures to sites of relatively hypercellular marrow." (Magnetic Resonance Imaging of the Bone Marrow in Hematologic Malignancies  bloodjournal.org)

Bilateral testing (taking sample from both sides) will be more reliable:  (Bone marrow biopsy for the staging of non-Hodgkin's lymphoma: bilateral or unilateral trephine biopsy? Tumori. 1995 Nov-Dec;81(6):410-3. PMID: 8804465 | Related articles)

Improving the sensitivity of the bone marrow biopsy test?

NOTE: Lymphoma cells are very very small.  For example, a one centimeter tumor has about 1 billion lymphoma cells.  So lymphoma cells will not be detected by many standard tests unless there are a significant number of cells to form a mass (a tumor) in the sample.

Returning to the analogy of testing for leaves in a pool, a sample taken with a bucket that has no leaves (tumors) might have small traces of leaf fragments (individual tumor cells) that are not visible with plain sight, which might be detected by other tests.

One very sensitive test for lymphoma cells is called PCR.  It can detect for the presence of genetic translocations (that are unique to some kinds of lymphoma in the sample).

Bcl-2/ t(14;18) Gene Rearrangement, Quantitative Real-Time PCR   Questdiagnostics 

"The t(14;18) translocation is characteristic of B-cell lymphomas, occurring in up to 90% of follicular lymphomas. It is also found in 20% to 30% of diffuse large B-cell lymphomas ..."

Also see: What is PCR Testing?  questdiagnostics

Resources

	You and Your Bone Marrow  cancerhelp.org.uk
	What if I am BCL2 Negative?
	Bone marrow biopsy

Research News

Successful response to rituximab as a single agent in bone non-Hodgkin lymphoma  ASCO