Bone marrow is a soft, spongy tissue that is in the center of most bones. Several types of cancer, including multiple myeloma, leukemia, and lymphoma, can develop in the bone marrow.
- red blood cells, which carry oxygen and carbon dioxide throughout the body
- white blood cells, which fight infection
- platelets, which help with blood clotting
The body usually produces these blood cells when it needs them, such as when old blood cells die. Bone marrow cancer develops when these cells replicate too quickly.
In this article, we discuss the different types of bone marrow cancer, including their symptoms and how to treat them.
The symptoms that a person experiences will depend on various factors, including the type of cancer, how aggressive it is, and its location in the body.
Symptoms of multiple myeloma may include:
- bone pain or fractures
- increased rate of infections
- changes in urination frequency
- nausea or vomiting
- unexplained weight loss
Symptoms of leukemia may include:
- shortness of breath
- bone pain
- unexplained weight loss
- night sweats
- enlarged lymph nodes
- a swollen spleen
- frequent infections
- pale complexion
- frequent and unexplained bruising
- prolonged bleeding from small wounds
- body aches
The symptoms of lymphoma are similar to those of leukemia, but they might also include the following:
- a persistent cough
- itchy skin
- lymph node pain after consuming alcohol
- loss of appetite
- abdominal pain
- itchy skin
- rashes or skin lumps
- feeling full or bloated, due to an enlarged spleen
Anyone experiencing these symptoms should see a doctor without delay.
Doctors categorize bone marrow cancer according to the type of cell that it affects.
Multiple myeloma is a type of cancer that occurs in the plasma cells, which form in the bone marrow. Plasma cells play an important role in the immune system and make the antibodies that the body needs to fight foreign bacteria.
Leukemias are cancers of the white blood cells. Sometimes, these types of cancer start in other types of blood cell and then spread, or metastasize, into the bone marrow.
Acute leukemias are fast growing cancers, while chronic leukemias grow slowly. There are several different types of leukemia, including:
- Acute lymphocytic leukemia (ALL): This type of leukemia is more common in children than in adults.
- Acute myeloid leukemia (AML): AML is most common in older adults, although children may also develop it.
- Chronic lymphocytic leukemia (CLL): This slow growing leukemia originates in the lymphocytes, a type of white blood cell, and it is more common in older adults.
- Chronic myeloid leukemia (CML): CML is rare. It starts in the bone marrow and spreads to the blood and other body tissues.
- Chronic myelomonocytic leukemia (CMML): This type of leukemia grows in the bone marrow cells that produce other blood cells. It primarily affects older adults.
In people with lymphoma, cancer develops in the lymphocytes, which circulate in the blood and lymph tissue after their production in the bone marrow. Lymphoma can occur in many places in the body, including the bone marrow.
There are two main types of lymphoma:
- Non-Hodgkin lymphoma: This type of lymphoma can develop anywhere in the body, and it affects many different types of lymphocyte.
- Hodgkin lymphoma: Hodgkin lymphoma is also a type of cancer that affects lymphocytes. It is distinct from non-Hodgkin lymphoma due to the presence of a specific type of abnormal cell called a Reed-Sternberg cell.
Before recommending any tests, a doctor will first ask the person about their medical history, current symptoms, and family history of bone marrow cancer.
A doctor may then request the following tests to help them diagnose bone marrow cancer:
Blood and urine tests: Blood or urine tests can detect a specific protein that enters the circulation due to multiple myeloma. Blood tests can also provide information on kidney function, electrolyte levels, and blood cell count.
Bone marrow aspiration: Doctors will use a specialized needle to puncture one of the bones under anesthesia and withdraw a small sample of bone marrow. A specialist will examine the sample under a microscope to look for cancerous cells.
Imaging tests: A doctor might use one of the following imaging tests to check for abnormal or damaged bones:
A doctor may also request some of these diagnostic tests during treatment to gauge the effectiveness of ongoing therapies or monitor the progression of the disease.
The type of treatment for bone marrow cancer depends on many factors, including the extent and type of the cancer and the person’s age and overall health. A cancer care team will tailor treatment to meet the person’s healthcare needs.
After diagnosing bone marrow cancer, a doctor or oncologist will discuss all of the available treatment options with the individual. They may recommend certain treatments to remove the cancer, prevent its spread, or minimize the symptoms to increase comfort and quality of life.
Following this discussion, they will present the person with a treatment plan. The plan may need regular adjustments depending on the response of the cancer to treatment and any adverse effects that the person experiences from chemotherapy or radiation.
When testing no longer identifies any abnormal cells in the blood or bone marrow, doctors will describe a person as being in remission.
Types of treatment include:
Chemotherapy uses medications to either kill cancer cells or prevent them from replicating. There are many different types of chemotherapy treatment.
A cancer team will often administer chemotherapy treatment by injection or through an intravenous (IV) drip. However, they will sometimes give the individual oral medications instead.
This treatment involves administering radiation directly into the cancer cells to prevent them from multiplying and spreading. A cancer specialist, called an oncologist, may use a machine that targets the affected bone marrow with a high powered beam of radiation.
If the cancer has spread throughout the body, the oncologist may recommend total body irradiation. The cancer care team will immerse an individual in radiation using a specialized machine. Alongside chemotherapy drugs, this irradiation is also often a preparatory step for a bone marrow transplant.
A person may need to stay in the hospital for several days following total body irradiation.
Stem cell transplant
A stem cell transplant may be an option in some cases, although not everyone with bone marrow cancer is a candidate for this type of treatment.
A person will receive high doses of chemotherapy or radiation therapy to kill the existing bone marrow before the IV administration of the stem cells.
The outlook for people with bone marrow cancer varies significantly among individuals.
If a person receives a diagnosis before the cancer spreads, they are more likely to respond well to treatment and remain free of cancer for years after going into remission.
In other people, bone marrow cancer is aggressive. Treatment may not be as effective for these people. Additionally, both cancer and its treatments can cause life threatening complications, such as severe infection or kidney failure.
A person should talk to their medical team about the different treatment options available.
Can the body reject a bone marrow transplant?
When a person receives a bone marrow transplant using stem cells from a donor, one of the possible risks is graft-versus-host disease (GVHD).
GVHD occurs when the cells from the donor — now part of the body’s immune system — attack the body, thinking that it is foreign. GVHD reactions can be mild or life threatening. They can start soon after the transplant or months afterward.
Doctors can treat GVHD using drugs that suppress the immune system.