Bone Marrow Metastasis of Solid Tumors: A Study of 174 Cases Over 2 Decades from a Single Institution in India

Comprehensive review of solid tumor bone marrow metastasis

Bone marrow metastasis (BMM) of solid tumors refers to a group of diseases that originate from non-hematopoietic malignant tumor cells invading the bone marrow (BM) through complex metastatic patterns. If BMM identification is delayed, the disease will rapidly develop into disseminated carcinogenesis of the BM, which manifests as a series of hematological disorders and microangiopathic hemolytic anemia, leading to serious life-threatening conditions. Although the study of solid tumor BMM is receiving increasing attention, study remains limited, and most descriptions are derived from case reports. Currently, clinicians have insufficient understanding of BMM, and BMM occurrence is often not recognized early or treated effectively, resulting in high mortality rates. In this article, we review the epidemiology, molecular mechanisms, clinical diagnosis, treatment, and prognosis of solid tumor BMM.

Clinical features and treatment of bone marrow metastasis

Bone marrow metastasis (BMM) refers to the metastasis of malignant tumours originating from nonhematopoietic tissues to the bone marrow. The nonhematopoietic malignant tumour cells metastasize to the bone marrow via heterogeneous dissemination or direct invasion to form metastases and the bone marrow is infiltrated by tumour cells, resulting in the destruction of its structure and the development of haematopoietic disorders. In the present study, the clinical characteristics, prognosis and treatment of BMMs were investigated. The main clinical manifestations were moderate anaemia and thrombocytopenia. Out of 52 cases, a total of 18 patients were not treated and the remaining patients underwent chemotherapy, radiotherapy, surgery or autologous stem cell transplantation in the Affiliated Tumour Hospital of Tianjin Medical University from September 2010 to October 2021. The primary tumours of bone marrow metastatic cancer were usually neuroblastoma and tumours originating from the breast and stomach. When bone metastases occur, patients are not necessarily accompanied by BMMs. In the present study, bone metastases occurred mainly in patients with breast and prostate cancers. The median overall survival of patients treated with antitumor therapy was significantly higher than that of untreated patients (11.5 vs. 3.3 months P<0.01). For patients with BMM, it is of great importance to actively evaluate the patient's condition and select the appropriate treatment plan for improving their prognosis.

Clinicopathological features and prognosis of breast cancer combined with symptomatic bone marrow metastases: A 10-year, single-center, real-world study of 67 cases

PURPOSE

Bone marrow metastasis (BMM) is uncommon in breast cancer (BC), and early diagnosis is challenging. BMM lacks definitive treatment options and poses a great threat to the survival of patients. Herein, we investigated the clinical features, prognosis, and factors affecting the prognosis of BC patients with symptomatic BMM to help improve the understanding of this disease and provide effective diagnostic and treatment strategies.

METHODS

Clinical data of 67 patients with BC and BMM were retrospectively analyzed for clinical characteristics, treatment, and prognosis of BMM. Univariate and multivariate analyses were performed to determine factors affecting overall survival following BMM (BMMOS).

RESULTS

Among patients with BMM, 86.6% were diagnosed after bone metastasis (BM), while 13.4% were diagnosed simultaneously with BM. A total of 73.1%, 13.4%, and 13.4% of the patients had hormone receptor-positive/human epidermal growth factor 2-negative (HR+/HER2-) tumors, HER2+ tumors, and triple-negative tumors, respectively. The most common symptoms of BMM were the coexistence of anemia and thrombocytopenia (26.9%), anemia (19.4%), and pancytopenia (17.9%). The median BMMOS was 7.6 months (95% CI, 3.9-11.3). Univariate and multivariate analyses showed that BMMOS was associated with platelet count <75 × 109 /L at the time of BMM diagnosis. The BMMOS of patients who underwent endocrine therapy, combined chemotherapy, and mono-chemotherapy after BMM was 15.7, 9.7, and 8.6 months, respectively, whereas that of untreated patients was 2.9 months, and the difference among the results was statistically significant (χ2  = 20.102, p < 0.0001). Changes in patient hemogram and/or body temperature during treatment were consistent with the overall effect of the disease (p < 0.0001).

CONCLUSION

BMM should be considered in BC patients with BM, an unexplained reduction in hemogram parameters, especially anemia and thrombocytopenia, and/or fever without chills. Active, effective, individualized treatment strategies can prolong BMMOS.

The necessity of bilateral staging bone marrow examinations for paediatric solid tumours

Background: Bone marrow aspirates and trephine biopsies (BMATs) form an important part of staging to detect bone marrow metastases of both haematological and nonhaematological neoplasms.Aim: The study’s primary aim was to determine whether it is necessary to perform bilateral BMATs on paediatric cancer patients as opposed to unilateral BMATs for the staging of solid tumours.Setting: The Paediatric Oncology Unit at Universitas Academic Hospital (UAH) in Bloemfontein, Free State, South Africa.Methods: A retrospective descriptive study was performed using laboratory reports from 01 January 2015 to 31 December 2019. Data were collected and reported on regarding the total number of staging BMATs performed, the average length of the trephine biopsies, the number of BMATs used for primary diagnosis, the number of bone marrow specimens where metastases were detected (left, right or both), the type of primary cancer and demographic information.Results: One hundred and eighteen patients were included for interpretation. Bone marrow metastases were detected in 28 patients, of which five patients had discrepant left and right results. These five cases included nephroblastoma (n = 2), Hodgkin lymphoma (n = 2) and a germ cell tumour (n = 1).Conclusion: Discrepant results were found in five cases (n = 28; 17.8%). Ultimately, the clinical implication of incorrectly staging solid tumours outweighs the small risks and discomfort of a bilateral bone marrow biopsy.