Gelatinous Marrow Transformation in an Imatinib-Treated CML Patient with Pancytopenia Following Severe Sepsis

Abstract

Dear Sir, We read with interest the article by Srinivas et al. [1] describing morphological changes in bone marrows of chronic myeloid leukemia (CML) patients treated with imatinib mesylate (IM). We would like to share our experience with one such case with an unusual marrow finding.A 60-year-old male, a chronic smoker, was first diagnosed with low-grade transitional cell carcinoma (TCC), urinary bladder in 2003 after he underwent endoscopic transurethral resection of a bladder tumor (TURBT). He suffered local recurrences in 2004 and 2005, and repeat TURBTs were done followed by administration of intravesical BCG, and subsequently gemcitabine and mitomycin. The third TURBT in 2005 was complicated by bladder perforation requiring lapartomic repair.He remained well till 2008 when routine follow-up hemograms revealed persistent leukocytosis. The spleen, impalpable clinically, was mildly enlarged on ultrasound. Investigations revealed hemoglobin 8.8 gm %, platelets 868 9 10 9 /l and TLC 68.3 9 10 9 /l with 56 % neutrophils, 2 % lymphocytes, 5 % eosinophils, 10 % basophils, 1 % promyelocytes, 13 % myelocytes and 13 % metamyelocytes. Leukocyte alkaline phosphatase score was five (reference range 40-100) and reverse transcriptase PCR for the p210 bcr-abl fusion transcript was positive.

Gelatinous transformation of bone marrow: rare or underdiagnosed?

“…The most common association had been reported with cases of malnourishment/starvation resulting from various causes like anorexia, chronic infections, or malignancy. 1 Though most of the initial case reports were associated with non-hematopoietic malignancies, recently GTBM has been reported in association with various hematopoietic malignancies like AML, 14 , 18 , 25 acute promyelocytic leukemia (APML) on All Trans Retinoic Acid, 70 acute lymphocytic leukemia (with and without dasatinib), 61 , 63 CML on imatinib, 47 , 55 , 56 , 72 CML in chronic phase, 50 myelodysplastic syndrome, 45 , 59 multiple myeloma 33 and myelofibrosis, 31 which also have been published from all over the world. In many of these cases, marked weight loss with anorexia was present, 44 , 63 , 74 , 77 thus pointing to the possibility that the underlying mechanism resulting in the development of GTBM remains the same as in the cases of chronic infections and malignancies, anorexia, and malnutrition.…”