Investigating practice patterns in bone marrow biopsies for cutaneous T-cell lymphoma: A multicenter clinician survey.

Abstract

e19075 Background: Bone marrow biopsy (BMB) is widely used to evaluate extracutaneous involvement in cutaneous T-cell lymphoma (CTCL), particularly in advanced disease stages (≥IIB) or given suspicion for systemic involvement. However, the routine implementation of BMB lacks standardization in clinical practice, leading to variability in its perceived utility and frequency of use. This study aimed to assess expert opinions regarding the role of BMB in the diagnosis, staging, and prognosis of CTCL, focusing on specialty-based differences among dermatologists, pathologists, and hematologists/oncologists. Methods: We developed a mixed-methods, 36-question electronic survey targeting 116 clinicians affiliated with USCLC/NCCN. Survey domains included participant demographics, BMB rationale, prognostic implications, and narrative feedback. Responses were analyzed using descriptive statistics, Fisher’s exact test, and UpSet plots to evaluate response patterns. Free-text responses underwent content analysis by two independent reviewers. Results: Among 102 respondents (41 dermatologists, 40 hematopathologists, 21 hematologists/oncologists), BMB was primarily performed to assess for unexplained hematologic abnormalities (23% dermatologists vs. 85% hematopathologists vs. 81% hematologists/oncologists; p<0.001) followed by the differential diagnosis of other T-cell lymphomas (46% dermatologists vs. 33% hematopathologists vs. 33% hematologists/oncologists; p=0.40). Dermatologists selectively utilized BMB for staging purposes (56% vs. 24% hematologists/oncologists, p=0.03). BMB findings rarely altered management (<25% of cases for 85% of respondents). Despite discrepancies in practice patterns, most experts agreed on work-up modalities including marker selection for flow cytometry and immunohistochemistry (CD3, CD4, CD5, CD7, and CD8) and inclusion of PET-CT (73.8%). A significant proportion of respondents (34%) reported that BMB findings are “not applicable” to their current practice, reflecting a combination of unclear guidelines, knowledge gaps, and genuine clinical irrelevance. Conclusions: These survey findings indicate that BMBs currently have minimal impact on patient management and outcomes. Observed practice pattern discrepancies among specialties highlight the need for updated evidence-based guidelines and targeted educational measures to improve the management of CTCL.