Myelofibrosis in Patients of Chronic Myeloid Leukemia in Chronic Phase at Presentation
Ambareen Hamid1, Sobia Ashraf1, Samina Qamar1
1Department of Pathology, King Edward Medical University (KEMU), Lahore, Pakistan.
Insights
Myelofibrosis is common in chronic myeloid leukemia patients, with advanced fibrosis frequently observed. Peripheral blood counts do not predict fibrosis severity, necessitating bone marrow biopsy for accurate assessment in chronic phase CML.
Area of Science:
- Hematology
- Oncology
Background:
- Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm.
- Myelofibrosis (MF) is a significant complication in CML, affecting bone marrow structure.
- Understanding the extent of MF is crucial for patient management.
Purpose of the Study:
- To determine the frequency and grade of myelofibrosis in chronic phase CML patients.
- To investigate the association between cytopenias/cytosis and the degree of myelofibrosis.
Main Methods:
- A descriptive study was conducted on 82 Philadelphia chromosome/BCR-ABL positive CML patients.
- Bone marrow aspirate and trephine biopsy were performed.
- Fibrosis grading utilized WHO revised classification 2016 with special stains (reticulin, trichrome).
Main Results:
- All studied CML patients exhibited some degree of myelofibrosis.
- WHO Grade MF 1 was present in 65%, Grade MF 2 in 27%, and Grade MF 3 in 8% of patients.
- No significant association was found between anemia, thrombocytocytosis, or leucocytosis and advanced fibrosis.
Conclusions:
- Bone marrow fibrosis is a universal finding in chronic phase CML.
- Advanced fibrosis (WHO Grade MF 2 and 3) is common.
- Bone marrow biopsy with special staining is recommended for all chronic phase CML cases due to the unreliability of peripheral blood counts as predictors of fibrosis.
Objective:
To determine the frequency and grading of myelofibrosis in patients of chronic myeloid leukaemia in chronic phase, and the association of cytopenias/cytosis with the degree of fibrosis.
Study Design:
Descriptive study.
Place And Duration Of Study:
King Edward Medical University, Lahore, from March 2015 to April 2017.
Methodology:
Patients of both genders and all age groups with Philadelphia chromosome/BCR-ABL positivity were included in the study. Detailed medical history and examination findings were recorded. Sample for CBC was taken in EDTA and run on automated haematology analyser. Bone marrow aspirate and trephine biopsy was done from posterior iliac crest. Bone marrow aspirate slides were stained with Giemsa stain. The trephine biopsy was processed and stained with haematoxilyn and eosin. Silver (reticulin) and trichrome staining was done on trephine biopsy to assess the degree of fibrosis. Grading of fibrosis was done according to WHO revised classification 2016.
Results:
Among the 82 cases, 65% (n=53) were having WHO Grade MF 1 myelofibrosis, 27% (n=22) WHO Grade MF 2 myelofibrosis; whereas, 08% (n=07) WHO Grade MF 3 myelofibrosis. CBC counts were analysed to see any association between anemia, thrombocytocytosis and leucocytosis with advanced fibrosis (p=0.148, 0.413 and 0.174, respectively).
Conclusion:
Some degree of bone marrow fibrosis was present in all patients of chronic myeloid leukemia, while advance fibrosis (WHO Grade MF 2 and 3) is also common. Peripheral blood counts are not predictor of increased fibrosis. Therefore, bone marrow biopsy with special staining should be done in all cases of chronic phase of CML.
