Bone Marrow Cancer

Bone marrow cancer is of the following types based on the cells affected:

1. Leukemia

Leukemia is the type of cancer in which uncontrolled proliferation of WBCs occurs. These WBCs may be immature or mature and interfere with the body’s regular functioning. The body’s defence mechanism gets disrupted, increasing susceptibility to infections. Leukaemia is further divided into:

Acute Leukemia:

In acute leukaemia, immature WBCs, called blasts, proliferate rapidly.

AML

ALL

Chronic Leukaemia: 

In chronic leukaemia cases, more mature cells rapidly multiply.

Chronic Lymphocytic Leukemia

Chronic myeloid leukemia

2. Multiple myeloma 

Multiple myeloma is the type of cancer that affects plasma cells. Plasma cells are responsible for making antibodies. 

3. Lymphoma 

Lymphoma is the type of cancer in which lymphocytes rapidly multiply, forming tumours that compromise the body’s immune system. Lymphoma is of two types:

1. Hodgkin’s lymphoma - affecting B lymphocytes

2. Non-Hodgkin’s lymphoma - involving B or T lymphocytes

3. Myelodysplastic Syndromes

This is a bone marrow disorder of usually elderly age. However, can be seen in young adults also. Usually presents with low Hb or WBC or platelet counts. Some patients require regular blood and platelet transfusions. Some patients require low to high intensity chemotherapy. Bone marrow transplant is curative if patient is fit and disease is in control.

Symptoms develop depending on the type of cancer, its location, severity, and how aggressive its progression is. 

Leukaemia

Leukaemia is a cancer of the WBCs. Symptoms that patients with leukaemia would present are:

1. Bone pain

2. Swollen lymph nodes

3. Unexplained weight loss of more than 10% body weight in a short period without specifically trying

4. Petechiae on the skin (pinpoint red dots)

5. Weakness and fatigue

6. Frequent infections since the body's defence mechanisms are affected

7. Fever and chills

8. Liver and spleen enlargement

9. Bruising easily

10. Night sweats

Multiple myeloma

Multiple myeloma is a common type of bone marrow cancer. Some of the symptoms are:

1. Anemia or low Hb

2. Deranged kidney parameters

3. Pain in the bone and increased risk of fracture

4. Weakness and fatigue

5. Increased susceptibility to infections

6. Confusion, increased thirst

7. Nausea and vomiting

Lymphoma

Lymphoma presents with the following symptoms:

1. Swollen lymph nodes in any part of body

2. Unexplained fever persisting for more than 2 weeks

3. Unexplained weight loss of more than 10% body weight in a short period without specifically trying 

4. Drenching night sweats

5. A persistent cough that doesn’t subside

6. Pain in the lymph nodes

7. Itchy skin, the appearance of rashes or skin lumps

8. Loss of appetite

9. Pain in the abdomen

10. An enlarged spleen gives rise to a feeling of bloated all the time.

Risk factors of bone marrow cancer are usually non-specific. However, some contributing factors may be:

1. Immunocompromised individuals (post-transplant or those taking immunosuppressant drugs, HIV patients)

2. Exposure to harmful radiation, chemicals, fumes, pesticides

3. Genetic predisposition

4. Smoking and drinking

5. Obesity

The doctor first assesses the medical history, and familial history and performs a physical examination. Following tests are advised to diagnose bone marrow cancer:

1. Blood test: A complete blood count is usually the first investigation which in large majority is able to show abnormal cells or abnormal blood counts like low or high white blood cell counts, low Hb or platelet counts.
   
   

2. Liver, kidney functions and metabolic profile: To assess liver functions, kidney function, electrolyte levels.
   
   

3. Bone marrow aspirate and Biopsy: This is usually the man diagnostic test along with flowcytometry, cytogenetics and molecular studies. Sometimes these investigations can be performed in blood itself.
   
   

4. PET scan or MRI or Skeletal survey can help detect extent of disease and thereby help in staging of disease.

The confirmatory test for bone marrow disorders is biopsy since it provides information about the specific type of cancer. Imaging techniques help assess how much the disease has progressed.

The treatment of bone marrow diseases depends on multiple factors such as age, the extent of spread and the overall health of the affected individual. Considering the above factors, the doctor may advise the following treatment options:

1. Chemotherapy: Specific drugs are injected into the veins to find and destroy cancer cells.

2. Radiation therapy: This treatment aims to reduce the size of tumour cells, lower pain, and kill cancer cells by delivering high-energy beams to a targeted organ. 

3. Bone Marrow Transplant: The cancerous bone marrow can be destroyed by use of medications and healthy bone marrow stem cells can be infused which are able to regenerate a healthy bone marrow. This procedure is also known as stem cell transplant.

4. Targeted drug therapy: These drugs specifically target cancer cells, and spares normal healthy cells unlike chemotherapy. This therefore has lesser adverse effects.

5. Biological therapy: Immune system of the affected individual can help destroy cancer cells.

If cancer is untreated, it can prove fatal owing to reduced immunity, increased susceptibility to infections, and bleeding. Infections are major concern in these diseases owing to low neutrophils.

The prognosis of patients having bone marrow cancer is highly individual specific. It has a lot to do with type of illness, its biology and genetics, extent of spread and their willpower and mental health. It also depends on how an individual responds to therapy.

1. What You Need to Know About Bone Cancer
2. Bone Marrow Transplant - The New frontiers of hope and life
3. Want to know more about Leukemia Treatment Options?

Reviewed by Dr. Rahul Naithani, Director, Cancer Care / Oncology, Bone Marrow Transplant, Hematology Oncology, Medical Oncology on 12-May-2022