Grading of marrow fibrosis in chronic myeloid leukemia--a comprehensive approach

In the course of Chronic myeloid leukemia (CML), appearance of increased number of blasts may herald evolution of accelerated phase as well as onset of marrow fibrosis (MF) thereby necessitating the need to perform trephine biopsy for correct diagnosis and appropriate treatment. In the existing grading systems of MF, a comprehensive view has not been taken of the variability of density and area occupied by reticulin and collagen fibres. To overcome this shortcoming, we quantitated the reticulin and collagen content of marrow, its pattern of distribution and percentage area occupied by each type of fibres in every individual case. We performed 50 bone marrow (BM) trephine biopsies in patients of CML in order to assess the incidence and degree of MF. Various grades of MF were correlated with peripheral smear including blast count, bone marrow aspirate and LAP score of the case. A positive correlation was found between increasing grades of MF and number of megakaryocytes in the BM.