Chronic myelocytic leukemia versus idiopathic myelofibrosis.A diagnostic problem in bone marrow biopsies

Abstract

Repeated bone marrow biopsies of 12 patients with chronic myelocytic leukemia (CML) and 13 patients with idiopathic myelofibrosis (IMF) were compared. The amount of cellularity, the composition of the cell population, and the stromal changes were assessed. Both diseases were divided into four stages, each with a consistent morphologic pattern. In CML, Stage 1 presented a tremendous increase in granulocytes and a drop of the erythroid series; Stage 2 showed a shift to myelocytes and a moderate increase of blasts; in Stage 3 there was a strong increase of blasts and the reappearance of red cells; and in Stage 4 hematopoietic cells disappeared with metastases of abnormal blasts to many organs. The stroma showed a progressive fibrosis so that by Stage 4 there was a totally fibrotic marrow. With IMF, Stage 1 presented a dysharmonic trilinear proliferation; in Stage 2 there was a maximum of cellularity, which remained trilinear; in Stage 3 there was a decrease of hematopoietic cells; and in Stage 4 these cells disappeared, but hematopoietic cells in dilated sinusoids of the empty marrow became apparent. The stroma showed a progressive fibrosis, ending by Stage 4 in a totally fibrotic marrow indistinguishable from the similar stage of CML. Careful analysis of the bone marrow biopsy findings permitted the stage of the disease and hence the prognosis to be determined; Stage 3 for CML means death within a short period of time. In clinically “acute” myelocytic leukemia, the biopsy helps to make the distinction between Stage 3 of an unsuspected CML and acute myelocytic leukemia.

Diagnostic and clinical relevance of the number of circulating CD34+ cells in myelofibrosis with myeloid metaplasia

“…This documents that the release of hematopoietic stem cells from the bone marrow is higher in patients with a myeloproliferative pattern of disease than in patients with a myelodepletive pattern. Moreover, the demonstration that the number of circulating CD34 ϩ cells better reflects the myeloproliferative characteristic of MMM than the myelodepletive pattern could be used to add to histological, 27 clinical, 13 or erythrokinetic 28 features in the search for criteria for classifying the disease. Since a correlation between marrow angiogenesis and myeloproliferation has been reported, 29 an important contribution could be to assess the influence increased angiogenesis exerts on the release of CD34 ϩ cells from the bone marrow.…”

Clinical efficacy and antiangiogenic activity of thalidomide in myelofibrosis with myeloid metaplasia. A pilot study

“…29 MVD was clearly increased if compared to normal controls (Table 4). Results from the two methods of evaluating angiogenesis adopted were absolutely comparable.…”

“…A bone marrow biopsy was performed in all patients before treatment; all marrows were reviewed by two of the authors to confirm the accuracy of the diagnosis and assess the pathological stage 29 and the micro-vessel density (MVD). Bone marrow biopsy was prepared from paraffin-embedded blocks.…”

Interferon alpha‐2b as treatment for Philadelphia‐negative chronic myeloproliferative disorders with excessive thrombocytosis

“…Diagnostic criteria for ET were those of the Polycythemia Vera Study Group (Murphy et al 1986). IM was diagnosed and staged according to Buyssens & Bourgeois (1977). The patient with HD had been treated with radiotherapy and vinblastine for stage I1 nodular sclerosis HD 10 years previously.…”