DOI 10.15372/SSMJ20180609
PATHOMORPHOLOGICAL ANALYSIS OF TREPANOBIOPTATES IN CHRONIC MYELOID LEUKEMIA AND CHRONIC LYMPHOCYTIC LEUKEMIA: ASSESSMENT OF THE PROGNOSTIC VALUE OF MYELOFIBROSIS WHEN COMPARED WITH CLINICAL DATA
Author Affiliations1Institute of Molecular Pathology and Pathomorphology, Federal Research Center for Fundamental and Translational Medicine 630117, Novosibirsk, Timakov str., 2
2Institute of Molecular Pathology and Pathomorphology, Federal Research Center for Fundamental and Translational Medicine 630117, Novosibirsk, Timakov str., 2
3Institute of Molecular Pathology and Pathomorphology, Federal Research Center for Fundamental and Translational Medicine 630117, Novosibirsk, Timakov str., 2
4Institute of Molecular Pathology and Pathomorphology, Federal Research Center for Fundamental and Translational Medicine 630117, Novosibirsk, Timakov str., 2
Abstract
The aim of the study was to study the relationship between the qualitative and quantitative characteristics of myelofibrosis and the clinical manifestations of chronic myeloid leukemia and chronic lymphocytic leukemia. Material and methods. A complex pathomorphological study of ilium bone trepanobioptates and a complex clinical-laboratory and instrumental examination of 154 patients with chronic myeloid leukemia and chronic lymphocytic leukemia were performed. Results. In patients in the chronic phase of chronic myeloid leukemia in the onset of the disease and with a loss of response to chemotherapy, the largest area of the spleen was detected with pronounced myelofibrosis, the smallest – in the absence of myelofibrosis. In patients in the onset or relapse of chronic lymphocytic leukemia, splenomegaly, hepatomegaly and generalized lymphadenopathy are most common in patients with myelofibrosis compared to patients without myelofibrosis. The expressed myelofibrosis in all cases was associated with hepatosplenomegaly. Comparing the morphometric and clinical data, it is established that in the chronic phase of chronic myeloid leukemia in the onset of the disease, the relative area of foci of initial myelofibrosis more than 60 %, the relative area of foci of pronounced myelofibrosis more than 40 %, and the granulocyte-megakaryocytic subtype of bone marrow tumor are associated with the development of relapse or progression of disease after 1st or 2nd line of chemotherapy. In the onset of chronic lymphocytic leukemia, the relative area of foci of initial myelofibrosis more than 20 %, the relative area of foci of pronounced myelofibrosis more than 11 %, and the diffuse type of bone marrow tumor lesion are associated with the development of relapse or progression of disease after 1st or 2nd line of chemotherapy.
Key words
References
- Domnikova N.P., Dolgykh T.Yu. The prevalence of myelofibrosis in chronic myeloid leukemia, multiple myeloma and chronic lymphocytic leukemia in various phases of the disease // Sibirskiy nauchnyy medtsinskiy zhurnal = Siberian Scientific Medical Journal. 2016. (5). 53–57. [In Russian].
- Software treatment of diseases of the blood system: Collection of algorithms for diagnosis and protocols for the treatment of diseases of the blood system / Ed. V.G. Savchenko. Moscow: Praktika, 2012. 1056 p. [In Russian].
- Rugal V.I., Bessmeltsev S.S., Semenova N.Yu. Features of niche-forming structures and bone marrow stroma in patients with chronic lymphocytic leukemia. Medline.Ru. 2013. 14. (2). 347–361. [In Russian].
- Binet J.L., Auquier A., Dighiero G., Chastang C., Piguet H., Goasguen J., Vaugier G., Potron G., Colona P., Oberling F., Thomas M., Tchernia G., Jacquillat C., Boivin P., Lesty C., Duault M.T., Monconduit M., Belabbes S., Gremy F. A new prognostic classification of chronic lymphocytic leukemia derived from a multivariate survival analysis // Cancer. 1981. 48. (1). 198–206.
- Buesche G., Georgii A., Duensing A., Schmeil А., Schlue J., Kreipe H. Evaluating the volume ratio of bone marrow affected by fibrosis: a parameter crucial for the prognostic significance of marrow fibrosis in chronic myeloid leukemia // Hum. Pathol. 2003. 34. (4). 391-401.
- Buesche G., Hehlmann R., Hecker H., Heimpel H., Heinze B., Schmeil A., Pfirrmann M., Gomez G., Tobler A., Herrmann H., Kappler M., Hasford J., Buhr T., Kreipe H.H., Georgii A. Marrow fibrosis, indicator of therapy failure in chronic myeloid leukemia – prospective long-term results from a randomized-controlled trial // Leukemia. 2003. 17. 2444–2453.
- Burkhardt R., Bartl R., Jager K., Frisch B., Kettner G, Mahl G., Sund M. Working classification of chronic myeloproliferative disorders based on histological, haematological and clinical findings // J. Clin. Pathol. 1986. 39. 237-252.
- Clough V., Geary G.C., Hashmi K. Myelofibrosis in chronic granulocytic leukemia // Br. J. Haematol. 1979. 42. 515-526.
- Crawford S.E., Stellmach V., Murphy-Ullrich J.E., Ribeiro S.M.F., Lawler J., Hynes R.O., Boivin J.P., Bouck N. Thrombospondin-1 is a major activator of TGF-beta1 in vivo // Cell. 1998. 93. 1159.
- Hallek M., Cheson B.D., Catovsky D., Caligaris-Cappio F., Dighiero G., Döhner H., Hillmen P., Keating M.J., Montserrat E., Rai K.R., Kipps T.J. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute-Working Group 1996 guidelines // Blood. 2008. 111. (12). 5446–5456.
- Kantarjian H.M., Bueso-Ramos C.E., Talpaz M., O'Brien S., Giles F., Faderl S., Wierda W., Beth Rios M., Shan J., Cortes J. Significance of myelofibrosis in early chronic-phase, chronic myelogenous leukemia on imatinib mesylate therapy // Cancer. 2005. 104. (4). 777-780.
- Kimura A., Hyodo H., Nakata Y., Kuramoto A. Chronic lymphocytic leukemia associated with bone marrow fibrosis: Possible role of interleukin 1α in the pathogenesis // Am. J. Hematol. 1993. 43. 47–50.
- Lazzarino M, Morra E, Castello A., Inverardi D., Coci A., Pagnucco G., Magrini U., Zei G., Bernasconi C. Myelofibrosis in chronic granulocytic leukemia: clinicopathological correlation and prognostic significance // Br. J. Haematol. 1986. 64. 227-240.
- Rankin E.B., Narla A., Park J.K., Lin S., Sakamoto K.M. Biology of the bone marrow microenvironment and myelodysplastic syndromes // Mol. Genet. Metab. 2015. Vol. 116 (1-2). P. 24-28.
- Tadmor T., Shvidel L., Aviv A., Ruchlemer R., Bairey O., Yuklea M., Herishanu Ya., Braester A., Levene N., Vernea F., Ben-Ezra J., Bejar J., Polliack A. Significance of bone marrow reticulin fibrosis in chronic lymphocytic leukemia at diagnosis: a study of 176 patients with prognostic implications // Cancer. 2013. 119. (10). 1853–1859.
- Thiele J., Kvasnicka H.M. Myelofibrosis – What′s in a Name? // Pathobiology. 2007. 74. (2). 89–96.
- Thiele J., Kvasnicka H.M., Facchetti F., Franco V., van der Walt J., Orazi A. European consensus on grading bone marrow fibrosis and assessment of cellularity // Haematologica. 2005. 90. 1128-1132.
- Thiele J., Kvasnicka H.M., Titius B.R., Parpert U., Nebel R., Zankovich R., Dienemann D., Stein H., Diehl V., Fischer R. Histological features of prognostic significance in CML: An immunohistochemical and morphometric study (multivariate regression analysis) on trephine biopsies of the bone marrow // Ann. Hematol. 1993. 66. 291-302.
Weistner A., Rosenwald A., Barry T.S. ZAP-70 expression identifies a chronic lymphocytic leukemia subtype with unmutated immunoglobulin genes, inferior clinical outcome, and distinct gene expression profile // Blood. 2003. 101. 4944–4951.
About Authors (Correspondence):
Dolgikh T.Yu. – candidate of medical sciences, senior researcher of laboratory of molecular cell mechanisms of neoplastic processes, e-mail: pathol@inbox.ru
Full Text
Received: 18/12/2018
Accepted: 18/12/2018
