Metastatic Bone Marrow Tumors Manifested by Hematologic Disorders: Study of Thirty-Four Cases and Review of Literature
DOI:
https://doi.org/10.6000/1927-7229.2014.03.04.1Keywords:
Bone marrow metastasis, leukoerythroblastosis, microangiopathic hemolytic anemia, bone marrow involvement, adenocarcinoma.Abstract
Purpose: Bone marrow metastasis of cancer is a sign of extensively hematogenous spreading of cancer and may be a terminal event of those patients. With the improvement of systemic chemotherapy for malignant disease, some patients may have longer survival. We plan to find out the clinical hematologic presentation and prognostic factors in cancer patients with bone marrow metastasis.
Materials & Methods: In this retrospective study, we reviewed the results of 162 bone marrow examination carried out in adult malignancy patients (colon, lung, gastric, breast and prostate cancers) between January 2002 and December 2012 in Changhua Christian Hospital. The indication for bone marrow study for those patients with hematologic disorders included: leukoerythroblastosis, microangiopathic hemolytic anemia, unknown etiology of anemia, thrombocytopenia, bicytopenia and pancytopenia. Statistics analysis used SPSS 18.0 and overall survival was analyzed with the use of Kaplan-Meier curves and the log-rank test.
Results: Thirty-four patients (20.9%) had evidence of involvement of the bone marrow by a solid tumor, most common cancers were prostate and lung. At the time of diagnosis, the most common hematologic disorders were leukoerythroblastosis and microangiopathic hemolytic anemia. Median survival after the diagnosis of bone marrow metastasis with supportive care only compared with definite treatments was 0.3 months and 20.6 months (p<0.0001). Patients with visceral organ metastasis (0.4 months vs 6.4 months, respectively; p <0.002) and anemia (2.1 months vs 6.4 months, p=0.031) had inferior survival. Patents without any cytopenia had better survival (12.5 months vs 4.1 months, p=0.029). Initial level of thrombocyte and neutrophil, bone marrow infiltration type (focal or diffuse) and disease status were not significant prognostic factor.
Conclusions: Visceral metastasis and anemia are most poor prognostic factors in solid cancers with bone marrow metastasis. Since the improvement of the diagnosis and treatment for cancers during the recent decades, a portion of patients can be had better disease control after definite treatment especially in breast and prostate cancers with bone marrow metastasis.
References
Anner RM, Drewinko B. Frequency and significance of bone marrow involvement by metastatic solid tumors. Cancer 39: 1337-44. http://dx.doi.org/10.1002/1097-0142(197703)39:3<1337::AID-CNCR2820390349>3.0.CO;2-X
Singh G, Krause JR, Breitfeld V. Bone marrow examination for metastatic tumor: aspirate and biopsy. Cancer 1977; 40: 2317-21. http://dx.doi.org/10.1002/1097-0142(197711)40:5<2317::AID-CNCR2820400546>3.0.CO;2-Z
Krishnan C1, George TI, Arber DA. Bone marrow metastases: a survey of nonhematologic metastases with immunohistochemical study of metastatic carcinomas. Appl Immunohistochem Mol Morphol 2007; 15(1): 1-7. http://dx.doi.org/10.1097/01.pai.0000213134.09160.14
Mohanty SK, Dash S. Bone marrow metastasis in solid tumors. Indian J Pathol Microbiol 2003; 46: 613-6.
Lechner K, Obermeier HL. Cancer-related microangiopathic hemolytic anemia: clinical and laboratory features in 168 reported cases. Medicine (Baltimore) 2012; 91(4): 195-205. http://dx.doi.org/10.1097/MD.0b013e3182603598
Ozkalemkas F, Ali R, Ozkocaman V, et al. The bone marrow aspirate and biopsy in the diagnosis of unsuspected nonhematologic malignancy: A clinical study of 19 cases. BMC Cancer 2005; 5: 144. http://dx.doi.org/10.1186/1471-2407-5-144
Wong KF, Chan JK, Ma SK. Solid tumour with initial presentation in the bone marrow--a clinicopathologic study of 25 adult cases. Hematol Oncol 1993; 11(1): 35-42. http://dx.doi.org/10.1002/hon.2900110105
Kaur G, Basu S, Kaur P, Sood T. Metastatic bone marrow tumors: study of nine cases and review of the literature. J Blood Disord Transfus 2011; 2: 3. http://dx.doi.org/10.4172/2155-9864.1000110
Braun S, Vogl FD, Naume B, et al. A Pooled Analysis of Bone Marrow Micrometastasis in Breast Cancer. N Engl J Med 2005; 353: 793-802.
Weckermann D, Müller P, Wawroschek F, et al. Micrometastases in bone marrow in ocalized prostate cancer: Correlation with established risk factors. J Clin Oncol 1999; 17: 3438-43.
Braun S, Pantel K. Clinical significance of occult metastatic cells in bone marrow of breast cancer patients. Oncologist 2001; 6(2): 125-32. http://dx.doi.org/10.1634/theoncologist.6-2-125
Ardavanis A, Kountourakis P, Orphanos G, Rigatos G. Low-dose capecitabine in breast cancer patients with symptomatic bone marrow infiltration: a case study. Anticancer Res 2008; 28: 539-41.
Bjelic-Radisic V, Stoger H, Winter R, Beham-Schmid C, Petru E. Long-term control of bone marrow carcinomatosis and severe thrombocytopenia with standard-dose chemotherapy in a breast cancer patient: a case report. Anticancer Res 2006; 26: 1627-30.
Kopp HG1, Krauss K, Fehm T, et al. Symptomatic bone marrow involvement in breast cancer--clinical presentation, treatment, and prognosis: a single institution review of 22 cases. Anticancer Res 2011; 31(11): 4025-30.
Kilickap S, Erman M, Dincer M, et al. Bone marrow metastasis of solid tumors: Clinicopathologic evaluation of 73 cases. Turk J Cancer 2007; 37: 85-8.
