The mother of one of my dearest friends has leukemia and I think lymphoma. She is elderly and has been undergoing chemo and I think radiation for a few months. I believe she had the disease for quite some time before it was actually diagnosed this past fall.
I’m not looking for medical advice, but i am wondering about a term that was used. My friend wrote to me today and said that her mother’s bone marrow test showed that “She has no more bone marrow, it’s all just fat. She has ‘empty bones.’ That’s the term they use.”
I did a Google (and a Yahoo) search and the only thing I came up with were a couple of inspiring stories about bone marrow transplants, some really lachrymose poetry, and a rock band :eek: .
Question: Have any of our medical experts ever heard the term “empty bones” in this context? Anybody else?
The implication was that the poor woman is being completely consumed by the cancer, and that it’s only a matter of a very short time. My friend and her family are pretty much preparing for the poor lady’s demise in the near future, exploring hospice and so on.
It means that the cellular elements that make up bone marrow, i.e. the tissue that makes red and white blood cells, along with platelets, has died off. Possibly due to the stress of the chemo and radiation therapy. The bone marrow is quite susceptible to the effects of the treatments designed to kill the cancer; it is a common complication.
If she has leukemia it’s actually a desired effect of the initial treatment. High dosages of bone marrow toxic drugs are used. The strategy is to kill off the abnormal cells (blasts) residing in the bone marrow. Assuming this is sucessful, bone marrow biopsy will show a hypocellular or “empty” marrow.
choosybeggar is indeed correct that with leukemia, the goal is to kill off the bone marrow. Unfortunately I noted only the word “lymphoma” in the OP. My bad.
Thanks guys. That was my next question. Is it the hope, then, that the bone marrow will re-grow, or is a transplant needed? My friend says they are giving her “transfusions.” I interpret this to mean ordinary blood. AFAIK no one in the family has been approached about marrow donation.
Depends on the type of cancer. In some cases, they go in planning to wipe out the bone marrow/cancer with treatment, then replace it either with the patient’s own non-cancerous marrow (harvested from a different site before treatment) or with donor marrow.
In other cases they hope the treatment knocks off the (hopefully) more sensitive cancer cells, and leaves enough native bone marrow to regenerate.
In yet other cases, the bone marrow is just unusually sensitive to the cancer treatment, and dies off en masse.
Warning: I am not an oncologist, and the above is a gross oversimplification about leukemias in general.
Although when extracting bone marrow from a donor, you have to physically penetrate the bone, the same is not true for giving bone marrow to a recipient. It is transfused in a similar way to blood, that is, intravenously. The bone marrow cells then migrate to the marrow and make themselves at home.
If she has leukemia, a typical therapeutic sequence includes induction (bone marrow toxic chemotherapy), recovery (normal stem cells repopulate the bone marrow), consolidation (a second round of marrow toxic chemotherapy), recovery (again repopulation), and finally, sometimes, bone marrow or stem cell transplant.
There is much variability in this general scheme. For instance, sometimes induction fails to wipe out the leukemia so a second round of induction is undertaken without a recovery. Additionally, many patients are not candidates for transplant. Transplant has many complications and the patient must have good underlying organ function (heart, lung, liver, and kidney) and there is an age threshold.
That said transplant is often the best hope for long term survival. Interestingly, the curative effect of transplantation derives from the slight immunological mismatches that exist between donor and patient. The donor cells engraft and “clean up” the leukemic cells that manage to survive chemotherapy. This is termed the graft-versus-tumor effect. We know that this effect is due to slight mismatches because cure rates are higher when matched, non-self marrow (allogenic) is grafted versus the patient’s own marrow (autologous) is grafted.
These mismatches cause problems for the patient as well, however. Clinically, this manifests as graft-versus-host disease (GVHD) which has primarily skin and digestive tract manifestations. The closer the donor “matches” the patient, the lower the likelihood of GVHD. But, according to several oncologists I’ve spoken with, they like to see a little GVHD, as they believe this correlates with a greater graft-versus-tumor effect and better cure rates.
Sorry for the tangent (I’m studying for my in-service exam and this really helps). Your friend’s mother is likely getting transfusions to help her during the induction or recovery periods. Red blood cell and platelet production stops for a bit. Red blood cells are necessary for oxygen transport and platelets for coagulation. These are routinely replaced by transfusions (sometimes LOTS of transfusions). White blood cell production is stopped by the chemotherapy as well. Except under extraordinary circumstances, however, white blood cells are not transfused.
Fascinating. Thanks, choosy.
My friend and her family are under the impression that since the bone marrow is “gone” that there will be no recovery. Given that this is an elderly lady who was probably sick for a long time before starting treatment, this may well be true, but from what you guys are telling me it’s not *necessarily * inevitable.