How often do you think a bone marrow biopsy is required?

It would depend upon your lab numbers- what they were and have been trending. Symptoms are also important to be aware of too. But usually another bmb is done if there’s a big change in your numbers.
Have they remained stable in the last year and a half?
For example, I had a bmb 5 years ago when mgus was first diagnosed but not needed another one - so far.

Hi @leslie2121 ,
Thank you for sharing your thoughts about this. Interestingly in my case, the only day my labs were at all different was the actual day of my bone marrow biopsy which was done in February 2025 with labs ordered STAT that day. They were done at a lab location I have only used that one day and do not care to use again. That bone marrow biopsy day only, my platelets decreased 400 on their own with me taking no meds (I turned down Hydrea which I was offered) and my red cells were lower than normal. Then my diagnosis was changed from ET to primary myelofibrosis. My labs before and after the bone marrow biopsy day showed high platelets, normal red cells, normal hemoglobin, slightly high white cells and everything else in normal range. My recent lab done July 2026 shows these similar results. So, yes, my labs are stable. My labs are not changing at all since 12/2024 when this entire saga began. I had no symptoms then and continue to have no symptoms. I also have no health issues other than a very enlarged not at all painful ever right ring finger PIP joint which specialists continue to disagree on the diagnosis of. I do not feel that I need another bone marrow biopsy at this time.

I had a bone marrow biopsy at diagnosis for ET 12 yrs ago. I was told no need for another unless labs indicated some progression to MF was going on.

I had a bone marrow biopsy while on 25mg prednisone and it showed 10-15%. I'm scheduled for another one in 3 months after I've been off prednisone for a month or two. After that my labs will determine the need.

I woild say once was enough, so long as there aren't any signs. I had high platelets and then had a bone marrow tesr.It has been 2 1/2 years. I see an oncologist.

I never had one since my ET is due to JAK2.

Hi @cbernhart1 ,
I agree. I had a bone marrow biopsy after asking for one from my first oncologist/hemotologist. 1/2025 when she insisted I had ET. I have CALR1 mutation so I asked her how she was so sure I had ET and was prescribing a very high dose of Hydrea for my size and weight. So she ordered my bone marrow biopsy and then changed my diagnosis to PMF 2/2025. She could not refer me to a MPN specialist because that insurance had none so she told me I could pay out pocket to see one which thought was not right. So I changed my insurance 1/1/2026 and finally saw a MPN specialist who honestly seemed like a flake as she not read my chart at all! She put down that I had JAK2 and CALR but I do NOT have the JAK2 mutation at all! She claimed she discovered the JAK2 gene when she was a student. Then she questioned my NGS data when I showed her my copy which she obviously had not read in my chart! She said her data would be better and wanted me to do all my testing over! I do not care to ever see her again! My other insurance did a lot of testing and nothing has changed in my opinion.

Hi @panamsandy ,
It is good you did not see the MPN specialist I did as she would be insisting on one and lots of other testing too! She might be an expert in JAK2 as she claimed she discovered that gene when a she was a student.

@panamsandy Doctor's seem to push for this test and if you are looking for a diagnosis, your labs can usually do that. I have PV JAK2 and my doctor offered me this test and said some patients need the confirmation of diagnosis. I asked if it would change my treatment at all and he said no and was fine with me not having
The bone marrow test.

The genetic mutation and blood tests are definitive for diagnosis now, so some docs don't do bone marrow biopsies any longer. Others like to have one biopsy done as a baseline against other biopsies they might have to do in the future.