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Megakaryocytic Clustering in Chronic Myeloid Leukemia: Can it be a Predictor of Clinical Outcome?
Zunairah Mughal1, Hira Babar2, Sobia Ashraf1
1Department of Pathology, King Edward Medical University, Lahore, Pakistan.
Insights
Megakaryocytic clustering in chronic myeloid leukemia (CML) patients is linked to poorer clinical outcomes. This finding highlights the importance of monitoring this specific bone marrow characteristic for better CML patient management.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm.
- Megakaryocytic clustering in bone marrow is a pathological finding.
- The clinical significance of megakaryocytic clustering in CML requires further elucidation.
Purpose of the Study:
- To compare the clinical outcomes of chronic myeloid leukemia (CML) patients with and without megakaryocytic clustering.
- To assess the association between megakaryocytic clustering and treatment response markers in CML.
Main Methods:
- A cross-sectional comparative study was conducted involving 94 patients with chronic phase CML.
- Bone marrow trephine biopsies were analyzed for megakaryocytic clustering.
- Clinical outcomes, including complete hematological response (CHR) and major molecular response (MMR) at 6 months and 1 year, were evaluated alongside Sokal scores.
Main Results:
- Megakaryocytic clustering was observed in 60.6% of patients.
- Patients with megakaryocytic clustering showed significantly higher rates of absent CHR, absent MMR at 6 months, and absent MMR at 1 year compared to those without clustering.
- A statistically significant correlation was found between megakaryocytic clustering and high Sokal scores (p<0.001).
Conclusions:
- Megakaryocytic clustering in CML is associated with poor clinical outcomes.
- The presence of megakaryocytic clustering predicts lower rates of complete hematological response and major molecular response.
- Sokal score, CHR, and MMR are important indicators influenced by megakaryocytic clustering in CML management.
Objective:
To compare clinical outcome in patients of chronic myeloid leukemia (CML) with and without megakaryocytic clustering.
Study Design:
Cross-sectional comparative study.
Place And Duration Of Study:
Pathology Department and CML Clinic Oncology Department, King Edward Medical University from March 2018 to March 2019. Methodology: Ninety-four patients diagnosed with chronic phase of CML were included. Complete record of complete blood count, splenomegaly, findings of bone marrow aspirate and trephine biopsy was noted. Bone marrow trephine biopsy was reviewed for megakaryocytic clustering. Sokal scoring was done; and follow-up data for clinical outcome, i.e complete hematological response (CHR) at 3 months and major molecular response (MMR) at 6 months and 1 year (as per Institute's protocol) was obtained. All the data were analysed using SPSS version 25.
Results:
Megakaryocytic clustering was present in 57 (60.6%) patients and absent in 37 (39.4%). In patients with megakaryocytic clustering, CHR was absent in 12 (21.1%), MMR at 6 months was absent in 21 (36.8%) and MMR at 1 year was absent in 25 (43.9%) patients. In patients without megakaryocytic clustering, absent CHR, MMR at 6 months and MMR at 1 year were seen in 1 (2.7%), 2 (5.4%) and 2 (5.4%x), respectively. The correlation of megakaryocytic clustering and high sokal score was found to be statistically significant with a p-value <0.001.
Conclusion:
Patients with megakaryocytic clustering have poor clinical outcome as indicated by their sokal score, absent CHR, MMR at 6 months and 1 year. Key Words: Chronic myeloid leukaemia, Megakaryocytic clustering, Complete haematological response, Major molecular response, Cytogenetic response.
