Bone marrow biopsy for CLL

Selina M. Luger, MD
Last Modified: September 22, 2002

Dear OncoLink "Ask The Experts,"

I had a blood test a few months ago and a moderately elevated white blood cell was reported "consistent with CLL". Approximately 6 weeks later, I had another test taken by another lab and the white blood cell count was unchanged. A bone marrow extraction was recommended to me after the 2nd test to provide a definitive diagnosis. I understand that a bone marrow extraction is very painful and I also understand that CLL is not treated unless symptoms develop or the white blood cell count soars. Since I have no symptoms and a white blood cell count which is only slightly elevated, I can't see any point in submitting to a bone marrow extraction. I have not returned for a bone marrow extraction nor have I had a blood test for several months. Am I wrong in my thinking here?

Selina M. Luger, MD, Director of the Leukemia Program and Assistant Professor of Medicine at the University of Pennsylvania, responds:

As you have mentioned, chronic lymphocytic leukemia (CLL) is a disease that is often diagnosed by blood work. Often we can confirm the diagnosis by doing specialized tests on the blood, without having to do a bone marrow biopsy test (which is not as horrible as you describe). Although we no longer feel that a bone marrow test is necessary to make a diagnosis if the special tests confirm CLL, a bone marrow test may still be done if the blood tests are not diagnostic, if there are abnormalities in the blood other than the elevated white blood count or to potentially provide some prognostic information based on the pattern of involvement of the bone marrow. As far as blood tests, in general I recommend that patients have blood tests and a doctor's visit regularly, (every 3 months at first).