National Center for Advancing and Translational Sciences Genetic and Rare Diseases Information Center, a program of the National Center for Advancing and Translational Sciences

Bone marrow necrosis

Not a rare disease Not a rare disease
In bone marrow necrosis, there is poor circulation of oxygen and nutrients to the bone marrow cells, causing the cells to die. Bone marrow is the spongy tissue inside some of your bones, such as your hip and thigh bones. It contains immature cells, called stem cells. The stem cells can develop into the red blood cells that carry oxygen through your body, the white blood cells that fight infections, and the platelets that help with blood clotting. Bone marrow necrosis often causes fever and bone pain, and is associated with blood cancers, in particular acute lymphoblastic leukemia (ALL) although it can be associated with other cancers and non-cancerous conditions (e.g., sickle cell anemia, tuberculosis, infection, and sepsis).[1][2][3]
Last updated: 4/8/2010
Signs and symptoms of bone marrow necrosis, include bone pain, fever, fatigue, and jaundice. The bone pain may be throughout the body or localized to the lower back and/or legs.[1][2][3] Laboratory findings may include anemia, thrombocytopenia, and elevated levels of lactic dehydrogenase and alkaline phosphatase.[1][2]
Last updated: 4/8/2010
Bone marrow necrosis is associated with acute lymphoblastic leukemia (ALL), and is often discovered prior to initial diagnosis or around the time of recurrence of ALL.[2]

Other associated cancers include lymphomas and solid tumors. Chronic myeloproliferative disorders have also been reported in association.  Non-cancerous associated conditions, include infection, tuberculosis, drugs, sickle cell disease, disseminated intravascular coagulation, hemolytic-uremic syndrome, antiphospholipid syndrome, and hyperparathyroidism.[1][2]

Cases of bone marrow necrosis have been reported in association with treatment with anticancer drugs, such as fludarabine, imatinib mesylate, and interferon alfa.[2]

In some cases, the cause of bone marrow necrosis cannot be determined.[1]

Last updated: 4/8/2010
Bone marrow necrosis is often associated with thrombocytopenia, anemia, low blood count (pancytopenia), and other complications that should be managed with supportive measures until the underlying disease is effectively treated. Once the necrosis stops, the bone marrow cells are able to grow and thrive again.[4]
Last updated: 4/8/2010
Prognosis of people with bone marrow necrosis depends on the age of the patient and associated disease. Children with acute lymphoblastic leukemia (ALL) and bone marrow necrosis appear to have the same prognosis as children with ALL without the necrosis.[3] Adults with bone marrow necrosis associated with a non-cancerous condition, may have a better chance of complete recovery and long term survival than adults with bone marrow necrosis associated with a blood cancer.[2] It can be hard to distinguish bone marrow necrosis due to a drug or condition like disseminated intravascular coagulation versus an underlying cancer. This can make prognosis difficult to predict.
Last updated: 4/8/2010

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  1. Paydas S, Ergin M, Baslamisli F, Yavuz S, Zorludemir S, Sahin B, Bolat F. Bone marrow necrosis: Clinicopathologic analysis of 20 cases and review of the literature. American Journal of Hematology. 2002;
  2. Matsue K, Takeuchi M, Koseki M, Uryu H. Bone marrow necrosis associated with the use of imatinib mesylate in a patient with Philadelphia chromosome-positive acute lymphoblastic leukemia. Ann Hematol. 2006;
  3. Inoue S, Monga R, Onwuzurike N. Bone Marrow Necrosis as a presenting feature of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer. 2007;
  4. Janssens AM, Offner FC, Van Hove WZ. Cancer. 2000; http://www.ncbi.nlm.nih.gov/pubmed/10760751. Accessed 4/8/2010.