Publication: Bone marrow histopathology in chronic myelogenous leukemia ,CML, evaluation of distinctive features with clinical impact
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Date
1999
Authors
Thiele, J. ; Kvasnicka, H.M. ; Fischer, R.
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Publisher
Murcia : F. Hernández
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DOI
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info:eu-repo/semantics/article
Description
Abstract
Bone marrow features in stable-phase
chronic myelogenous leukemia (CML) are characterized
by a striking heterogeneity which is determinable by
appropriate means including representative pre-treatment
trephine biopsies, immunohistochemistry and morphometry.
Cell lineages involved to a variable extent consist
not only of neutrophil granulopoiesis, but include also
megakaryocytes, erythroid precursors, resident macrophages
and lymphocytes. Moreover, the stromal
compartment, in particular reticulin and collagen fibers,
plays a pivotal role in the disease process. Following
morphometric analysis significant correlations may be
calculated between histological parameters and clinicallaboratory
findings. Relevant interactions are detectable
between number of megakaryocytes and their precursors
with fiber density. This finding is in line with the close
functional relationships between megakaryopoiesis and
fibroblasts regarding the complex pathomechanisms of
myelofibrosis. Moreover, other correlations are
observable between reduction of erythropoiesis or
increase in fibers with clinical features like anemia,
percentages of myelo- and erythroblasts in the peripheral
blood, spleen size or LDH level. These variables are in
keeping with more advanced stages of CML which
indicate a transition to myeloid metaplasia and thus exert
a significant impact on survival. Consequently, the
different risk profiles of patients are determined by both
clinical and morphological parameters of predictive
value. Regarding the latter, extent of myelofibrosis,
amount of erythroid precursors and numbers of myeloerythroblasts
in the peripheral blood are significantly
associated with prognosis. For this reason, it should be
mandatory to enter morphological criteria into
prospective clinical trials on CML, not only for
diagnotic purpose, but also for a proper evaluation of
different survival patterns.
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