Why is it important to have a bone marrow biopsy before myeloma treatment is started? The importance of a bone marrow biopsy, I would say that maybe 50 years ago you could probably get away with just saying, huh, this patient has all the characteristics of multiple myeloma on their x-rays on their blood test. We don't need to see the myeloma, right? We know this person has myeloma and you'd be correct. I mean, the clinical characteristics of myeloma are fairly distinct and the simple blood tests that you can do are fairly straightforward. In this day and age, you can't do that. That's not, I wouldn't say that's not even cutting-edge medicine. That's not even standard of care anymore because now the ability to understand what that myeloma looks like and what your myeloma looks like because remember it's multiple myeloma and it really means that there are multiple different flavors and variations of myeloma that yours might be different than somebody else's. So understanding with these new technologies like genetic sequencing, FISH, flow cytometry, understanding why those myeloma cells are different, allows us to customize a person's treatment. It also allows us to say, huh, you have myeloma that we know based on your genetic fingerprint of the myeloma that you probably respond fairly well to therapy and we can go with a standard route of therapy. Or your myeloma has a genetic fingerprint that looks really, really difficult to treat and we will have to lean on you harder in order to get a good outcome. So the bone marrow biopsy provides the myeloma cells to actually allow us to fingerprint an individual's myeloma and then make recommendations as to how are you going to do, what's the right treatment therapy. And then as we talked about earlier, there's additional genetic information that we don't know what to do with now. But five years from now, that may be incredibly important because a new drug has been developed. There are targeted therapies that are developed in other cancers like lung cancer that all of a sudden might be relevant for myeloma. And if we didn't know that about your myeloma, we couldn't say, oh, your myeloma has this fingerprint and now there's a new drug out there that cures this myeloma. And if we didn't know that about your myeloma, you wouldn't be eligible for that kind of treatment. So I think that everybody should have their bone marrow biopsies done. Everybody should have as much detail that can be derived from their myeloma, including next generation sequencing if they have that capability. All those things I think the patients should have done from the very beginning. So there's a few reasons why you generally want to start, you have a bone marrow before you start treatment. One is you really get the full staging picture because if you've already started treatment and now there's 30% myeloma in the marrow, was there 90% when you started or not? The other is that you start to disturb the genetics. So even though we think of myeloma as one disease, even within an individual, there's usually at least four to six subclones. So let's say one of those subclones has a genetic abnormality, let's say in 1114 that we may want to give an ediclax to later, but you get enough treatment where that subclone goes away and now we don't detect that, we may not think about that as a potential future option.
HealthTree • June 11, 2025
