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Myelophthisis — SCE Medical Oncology MCQ

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ModerateOncological EmergenciesMyelophthisisSCE Medical Oncology

A 60-year-old man with metastatic prostate cancer develops progressive lower limb weakness over 48 hours. MRI of the entire spine shows no spinal cord compression but does reveal diffuse bone marrow infiltration. His FBC shows Hb 68 g/L, platelets 35 × 10⁹/L, WBC 2.1 × 10⁹/L. Blood film shows leucoerythroblastic picture. What is the diagnosis?

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Correct answer: E — Bone marrow infiltration (myelophthisis) from metastatic prostate cancer

Diffuse bone marrow infiltration by metastatic cancer (myelophthisis) can cause pancytopenia with a leucoerythroblastic blood film (nucleated red cells, immature white cells, teardrop poikilocytes). This is particularly common in prostate cancer with extensive bone metastases. It represents a poor prognostic sign. Management includes treatment of the underlying cancer (hormonal therapy, chemotherapy), transfusion support, and consideration of G-CSF if neutropenic. The progressive weakness may be multifactorial (spinal instability, anaemia).

Reference: ESMO 2024 Prostate Cancer Guidelines; Hematology principles in oncology