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Prognostic evaluation of initial bone marrow histopathological features in chronic granulocytic leukemia
F Cervantes1, C Rozman, E Feliu
1Escola Professional d'Hematologia Farreras Valenti, Universidad de Barcelona, Spain.
Insights
Bone marrow biopsy findings in chronic granulocytic leukemia (CGL) offer limited prognostic value. Features like fibrosis and megakaryocyte count do not significantly improve predictions when combined with existing CGL prognostic systems.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Chronic granulocytic leukemia (CGL) is a myeloproliferative neoplasm.
- Prognostic indicators are crucial for managing CGL patients.
Purpose of the Study:
- To assess the prognostic significance of bone marrow biopsy features in nonblastic Ph1-positive CGL.
- To determine if bone marrow findings add predictive value to established CGL prognostic systems.
Main Methods:
- Correlation of initial bone marrow biopsy features with clinical and hematological parameters in 100 CGL patients.
- Analysis of reticulin fibrosis and megakaryocyte counts.
- Actuarial survival studies and multivariate regression analysis.
Main Results:
- Marked diffuse reticulin fibrosis and >15 megakaryocytes/mm³ were associated with poorer prognosis (p=0.0005 and p=0.01, respectively).
- Reticulin fibrosis correlated with white blood cell count and peripheral blast percentage.
- Bone marrow features lost prognostic influence in multivariate analysis with existing CGL prognostic systems.
Conclusions:
- Bone marrow biopsy findings provide minimal additional prognostic information in CGL.
- Established prognostic systems are sufficient for predicting outcomes in CGL.
Abstract:
In 100 patients with nonblastic Ph1-positive chronic granulocytic leukemia (CGL) the main features from the initial bone marrow biopsy were correlated with other clinical and hematological parameters and analyzed for prognostic significance. The mean number (+/- SD) of megakaryocytes per square millimeter of marrow tissue was 25.9 +/- 18.8. Marked reticulin fibrosis was observed in 19% of the patients but in only 5 cases it was diffuse, whereas collagen deposition was found in 10 patients. Reticulin fibrosis correlated significantly with white blood cell count and peripheral blood blast cell percentage, but not with platelet count. Actuarial survival studies demonstrated that marked diffuse reticulin fibrosis (p = 0.0005) and more than 15 megakaryocytes/mm3 of marrow tissue (p = 0.01) were associated with a poorer prognosis. However, they lost their prognostic influence when included in a multivariate regression model together with the patients' relative risk according to the currently most widely accepted CGL prognostic system. Such results indicate that bone marrow biopsy features add little prognostic weight to known prognostic indicators in CGL.