second opinion on bone marrow biopsy

[Cmall]

I believe we are going to push to get a second opinion on a bmb for my father in law. We are in the Chicago area though he is in MO. The lab that did the first biopsy normally sends to Mayo for second opinion. Would it be fairly safe to go along with that or would we be better off recommending Univ of Chicago or Northwestern or????? Any and all feedback is always truly appreciated. My best to all of you. Cheryl

[Neil Cuadra]

The Mayo Clinic has a lot of expertise with MDS. They should be able to give you a trustworthy second opinion.

Chances are that your father-in-law is going to have other bone-marrow biopsies in the future. Evaluating the differences between this one and the next one will be just as important as getting this one evaluated. Doctors will want to know if the disease is progressing, abating, or changing.

[bun]

I agree with Neil's response. Mayo is an MDS Center of Excellence, so their pathologists definitely see more examples of bone marrow failure "marrow" than other hospitals. I'm relating my husband's story that includes Mayo.

Sometimes it takes awhile for a definite diagnosis of MDS. If there are no chromosomal abnormalities, there isn't a "smoking gun" to say definitely a patient has MDS. Pathologists & Hematologists don't want to mistakenly diagnose MDS. Sometimes it takes looking at changes over time before a diagnosis is made. It took 5 bone marrow biopsies over the course of 2 years before Mayo pathologists were comfortable saying my husband has MDS.

My husband's local clinic is in the Minneapolis, MN area. His first BMB wasn't sent on for a 2nd opinion, but a few months later his 2nd BMB was. Still no official diagnosis, but it was helpful to know experts at Mayo agreee with his local pathologist & hematologist. From that point on, his BMB slides were seen by both places. From the start, MDS was suspected ... as was the posibility that an autoimmune condition could be causing his bone marrow problems ... or that his condition was very early stages of an eventual lymphoma.

For your father in law ... Learn what you can about MDS & other bone marrow failure diseases. Ask many questions of his doctor to understand. If a BMB is inconclusive, understand why & what will be done to monitor further.

Your father in law may want to be seen at an MDS center of excellence at some point in time. For my husband, we did that after 1 year & a 3rd BMB & things were still inconclusive. I would highly recommend Mayo for hard to diagnose problems or as a second opinion. They are world renown.

We have been very pleased with how my husband's local hematologist & pathologists and Mayo hematologist & pathologists work together. We know an eventual stem cell transplant will occur at Mayo. Now we are looking to the experts for help in identifying when. A general suggestion: if a SCT is possible in one's situation ... get testing done to find a donor. The availability, etc likely will impact decisions related to timing.