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Pediatric bone marrow cellularity: are we expecting too much?
S E Friebert1, L B Shepardson, S B Shurin
1Department of Pediatric Hematology/Oncology, Rainbow Babies and Children's Hospital, Cleveland, OH 44106, USA.
Insights
Pediatric bone marrow cellularity is lower than previously thought and declines with age until five years old. These findings help establish normal values for pediatric patients undergoing diagnosis or treatment.
Area of Science:
- Hematology
- Pediatric Oncology
- Biostatistics
Background:
- Accurate bone marrow cellularity assessment is crucial for diagnosing and monitoring pediatric illnesses.
- Established normal values for pediatric bone marrow cellularity are lacking.
- This data is vital for evaluating pediatric patients and potential sibling donors for transplantation.
Purpose of the Study:
- To establish well-defined, age-related normal values for bone marrow cellularity in pediatric patients.
- To provide a reference for accurate diagnosis and treatment monitoring in pediatric hematologic and oncologic conditions.
Main Methods:
- Retrospective review of 448 bone marrow core biopsy or clot specimens from patients aged 1 to 18 years.
- Exclusion of patients with hematopoietic malignancies or conditions affecting marrow cellularity.
- Standardized collection and fixation of all samples from the posterior iliac crest.
Main Results:
- Mean bone marrow cellularity across all pediatric samples was 65.4%.
- Cellularity significantly declined with age, highest in those younger than 2 years (79.8%) and decreasing until age 5.
- Cellularity stabilized in older pediatric age groups (10-18 years).
Conclusions:
- Current pediatric bone marrow cellularity values are lower than previously estimated.
- Age is a significant factor, with cellularity declining until age 5 and stabilizing thereafter.
- Diagnostic differences in cellularity were minimal after adjusting for age.
Purpose:
Accurate assessment of marrow cellularity is necessary for establishing diagnoses and monitoring the effects of treatment in a large number of malignant and nonmalignant pediatric illnesses, and for evaluating sibling donors for transplantation. However, normal values for age-related bone marrow cellularity in pediatric patients have not been well established. This study was designed to better define pediatric normal values for bone marrow cellularity.
Patients And Methods:
A retrospective review of 448 bone marrow core biopsy or clot specimens, including 45 samples from healthy donors, were taken from the posterior iliac crest of patients aged from younger than 1 to 18 years (55% male). All samples were collected and fixed in a standardized fashion. Patients with hematopoietic malignancies and other systemic conditions known to impact marrow cellularity were excluded.
Results:
The mean cellularity of the entire sample was 65.4%. Cellularity was similar in boys and girls, but varied (p < 0.001) with age. Cellularity was highest in patients younger than 2 years (79.8%), and declined in patients 2 to 4 years old (68.6%) and 5 to 9 years old (59.1%). Cellularity remained stable in older patients (60.1% and 61.1%, respectively, in patients 10 to 14 and 15 to 18 years of age). Adjusting for age and gender, mean cellularity was similar in patients with an underlying nonhematologic malignancy compared to health donors but was roughly 6% higher in patients with hematopoietic disorders.
Conclusions:
This study demonstrates that average cellularity during the first two decades of life, using current techniques of marrow collection and standardized analysis, is lower than previously estimated. In addition, cellularity declined with age until the age of 5 years, but was similar thereafter. After adjusting for age, differences according to diagnosis were relatively small.