How often will I need to have a bone marrow biopsy?

How often will I need to have a bone marrow biopsy? Everyone who has a diagnosis of myelodysplastic syndromes has to have at least one bone marrow biopsy. At that point, it really depends on whether somebody has a lower risk myelodysplastic syndromes or a higher risk myelodysplastic syndromes. Somebody who has a lower risk myelodysplastic syndromes may have some subtle blood count abnormalities, not require blood or platelet transfusions, not have frequent infections. That person I may follow over time, sometimes for years, without ever performing another bone marrow biopsy. One of my patients once referred to that as having myelodysplasio syndrome. They didn't like having the diagnosis. They didn't like having to fight the traffic in Miami to come see me. It didn't inconvenience their life very much. On the other hand, somebody who has a higher risk myelodysplastic syndromes, where their blood counts may be profoundly low, they may require frequent blood or platelet transfusions, and they require therapy, may undergo more frequent bone marrow biopsies to assess the efficacy of that therapy. Often we'll do a bone marrow biopsy at least after four months of therapy, often after six months, and sometimes every three months thereafter. If patients are receiving any therapy or not, meaning certain chemotherapy, or if they are in clinical trial, so clinical trials may mandate specific numbers of bone marrow biopsies after a couple of cycles of trial treatment. Other patients who receive bone marrow transplant, there are certain restaging bone marrow biopsies we perform. We perform bone marrow biopsy 30 days after transplant, then at three months, then at six months, one year, and two years after transplantation. This is to assess if there is any recurrence of myelodysplastic syndrome or not, because up to 40-50% of the patients may have disease recurrence even after transplantation. Although transplant is curative, but it doesn't unfortunately cure everyone. About 50% of the patients have recurrence of their disease within six months of transplant procedure if they were to have recurrence of MDS. Up to 80% who have recurrence of disease will have recurrence within two years of transplant. Therefore, since only minority will be at risk of recurrence after two years, we generally do not perform any restaging bone marrow biopsies after two years, as far as they continue having normal blood counts and no concern of potential recurrence of their disease.