Bone marrow malignancy

In selected patients, erythropoietin may also be useful for the treatment of anemia due to primary bone marrow disorders and secondary anemias. This includes patients with aplastic anemia and other bone marrow failure states, myeloproliferative and myelodysplastic disorders, multiple myeloma and perhaps other chronic bone marrow malignancies, and the anemias associated with chronic inflammation, AIDS, and cancer. Patients with these disorders who have disproportionately low serum erythropoietin levels for their degree of anemia are most likely to respond to treatment with this growth factor. Patients with endogenous erythropoietin levels of less than 100 IU/L have the best chance of response, though patients with erythropoietin levels between 100 and 500 IU/L respond occasionally. These patients generally require higher erythropoietin doses (150-300 IU/kg three times a week) to achieve a response, and responses are often incomplete. 

Bone marrow malignancies are primarily subject for MR diagnostics, since MRI can directly display the bone marrow components. The role for MDCT is on the one hand to show the matrix of a bone tumor and on the other hand to evaluate the extension of osseous destructions and to assess the fracture risk. More and more whole-body exams are performed in patients with multifocal metastases or multiple myeloma. 

However, the normal cells that line the oral cavity and gastrointestinal tract, and cells of the gonads, bone marrow, hair follicles, and lymph tissue are also rapidly dividing cells and are usually affected by these drugs. Thus, antineoplastic drugs may affect normal as well as malignant (cancerous) cells. 

Birnbaum T, Roider J, Schankin CJ, Padovan CS, Schichor C, Goldbrunner R, Straube A (2007) Malignant gliomas actively recruit bone marrow stromal cells by secreting angiogenic cytokines. J Neurooncol 83 241-247... 

O The acute leukemias are hematologic malignancies of bone marrow precursors characterized by excessive production of immature hematopoietic cells. This proliferation results in a large number of immature cells (blasts) appearing in the peripheral blood and bone marrow causing failure of normal hematopoiesis. 

O The acute leukemias are diseases of bone marrow resulting from aberrant proliferation of hematopoietic precursors. The hallmark of these malignancies is the leukemic blast cell, a visibly immature and abnormal cell in the peripheral blood that often replaces the bone marrow and interferes with normal hematopoiesis. These blast cells proliferate in the marrow and inhibit normal cellular elements, resulting in anemia, neutropenia, and thrombocytopenia. Leukemia also may infiltrate other organs, including the liver, spleen, bone, skin, lymph nodes, and central nervous system (CNS). Virtually anywhere there is blood flow, the potential for extramedullary (outside the bone marrow) leukemia exists. 

In older adults, AML is either more likely to arise from a proximal bone marrow stem cell disorder, such as myelodys-plastic syndrome (MDS), or present as a secondary leukemia resulting from treatment with prior chemotherapy or radiation for an earlier malignancy. These forms of AML are notoriously less responsive to chemotherapy and thus have a lower CR rate and EFS.20... 

Anonymous. Allogeneic peripheral blood stem-cell compared with bone marrow transplantation in the management of hematologic malignancies An individual patient data meta-analysis of nine randomized trials. J Clin Oncol 2005 23 5074-5087. 

Thorpe, P.E., Mason, D.W., Brown, A.N.F., Simmonds, S.J., Ross, W.C.J., Cumber, A.J., and Forrester, J.A. (1982) Selective killing of malignant cells in a leukaemic rat bone marrow using an antibody-ricin conjugate. Nature (London) 297, 594. 

Various malignancies can also induce an anaemic state. This is often associated with decreased serum EPO levels, although iron deficiency, blood loss or tumour infiltration of the bone marrow can be complicating factors. In addition, chemotherapeutic agents administered to this patient group often adversely affect stem cell populations, thus rendering the anaemia even more severe. 

Anemia of chronic disease Anemia of the elderly Malignant bone marrow disorders Peripheral... 

Leukemia, lymphoma, Hodgkin s disease, or multiple myeloma / Generalized malignancy / Chronic renal failure of nephritic syndrome / Patients receiving immunosuppressive therapy / Organ or bone marrow transplant recipients... 

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