Bone marow histopathology in chronic myelogenous leukemia (CML)- evaluation of distinctive features with clinical impact

• Thiele, J. ^[1] ; Kvasnicka, H.M. ^[1] ; Fischer, R. ^[1]
  1. [1] University of Cologne

     University of Cologne

     Kreisfreie Stadt Köln, Alemania

     
• Localización: Histology and histopathology: cellular and molecular biology, ISSN-e 1699-5848, ISSN 0213-3911, Vol. 14, Nº. 4, 1999, págs. 1241-1256
• Idioma: inglés
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• Resumen

  • Bo ne ma rrow fea tures in stabl e-ph ase chronic myelogenous leukemia (CML) are characterized by a striking heterogeneity which is determin abl e by appropriate means including representative pre-treatment trephine biopsies, immunohistochemistry and morphometry. Cell lineages involved to a variable extent consist not only of neutrophil granulopoiesis, but include also megakaryocytes, erythroid precursors, resident macroph ages a nd lymph ocytes. Mo reove r, th e stro ma l compartment, in particular reticulin and collagen fibers, pl ays a pivotal role in the disease process. Following morphometri c analysis significant correlations may be calculated between histological parameters and c1inicallaboratory findings. Relevant interactions are detectable between number of megakaryocytes and their precursors with fiber density. This finding is in line with the close functional relationships between megakaryopoiesis and fi broblasts rega rding the complex pathomechanisms of mye lofib rosis. Mo reove r, o th er co rr e la ti o ns a re obse rvab le be twee n redu c ti o n of e ryt hro po iesis o r inc rease in fibe rs with clinical fea tures like anemi a, percentages of myelo- and erythroblasts in the peripheral blood, spleen size or LDH level. These variables are in keeping with mo re adva nce d stages of C ML whi ch indicate a transition to mye loid metaplasia and thus exert a sig nifica nt impac t o n survival. Conse qu entl y, th e different risk profiles of patients are determined by both cl ini cal and mo rpho logica l parame te rs of predi c ti ve va lu e. Rega rding the latt e r, extent of mye lofibrosis, amount of erythroid precursors and numbers of myeloerythroblasts in the peripheral blood are significantly associated with prognosis. For this reason, it should be ma nd a to ry to e nt e r mo rph o log ica l c rit e ri a int o pros pec ti ve clini ca l tri a ls o n C M L, no t o nl y fo r diagnoti c purpose, but also fo r a prope r evaluation of diffe rent survival patterns.