Bone marrow curettage in myelodysplastic disorders. A stimulus for regeneration in disturbed hematopoiesis.

Bilateral bone marrow curettage of the iliac crest was performed in eight patients with marked anemia resulting from various myelodysplastic syndromes. The procedure was performed with the idea that an element of faulty hematopoietic microenvironment existed and that regeneration of normal marrow might occur in areas distant from the site of curettage. Four of the eight failed to respond to this procedure and no long-term response was obtained. One of the "failed" patients had a delayed response 18 months after the curettage was performed. In four patients, the procedure proved to be successful and adequate hemoglobin levels were achieved (10 to 14 g/dL) with reduction of the blood transfusion requirement. The diseases of two of these patients are still in remission 26 to 96 months after the procedure was performed. The procedure is recommended for patients with anemia refractory to conventional therapy and in whom a faulty hematopoietic microenvironment may be present.