Morphological Changes in Bone Marrow Post Imatinib Therapy in Chronic Phase CML: A Follow up Study on Sequential Bone Marrow Aspirates and BiopsiesCorrespondence Address :
Dr. Usha Rusia,
Professor, Department of Pathology, University College of Medical Sciences & Guru Teg Bahadur Hospital,
Dilshad Garden, Shahadra, Delhi-110095, India.
Introduction: Imatinib mesylate is used extensively for first line treatment of Chronic Myeloid Leukemia (CML). However, not many studies have documented morphological changes in bone marrow biopsies produced during Imatinib therapy with reference to myelofibrosis.
Aim: To document the morphological changes produced in the bone marrow during Imatinib therapy.
Materials and Methods: This longitudinal study followed up 75 Philadelphia Chromosome Positive Chronic Myeloid Leukemia with chronic phase(Ph+ CML- CP) patients sequentially, receiving 400-600mg Imatinib over a period of 12 or more months. Haematologic parameters were measured at admission, 2 weeks, 1 month, 3 months, 6 months and 12 or more months. Morphologic changes in bone marrow aspirate and biopsy were evaluated at admission, 6 months and =12 months of treatment in accordance with National Comprehensive Cancer Network(NCCN) guidelines.
Results: Complete Haematologic Response (CHR) was seen in 47.1%, 80%, 85.4%, 90.4% at =1 month, 3 months, 6 months and 12 months respectively after therapy. It was noted that patients not showing CHR by 3 months were less likely to show CHR at 6 months and beyond. Bone marrow aspirates and biopsies showed reduction in cellularity and myeloid precursors with regeneration of erythroid precursors in 70-83% at =12 months. A significant decrease in myelofibrosis (p-value< 0.04) was noted as early as 6 months. Mild to moderate hypoplasia was noted in 31.8% of biopsies within 6 months. Pseudo gaucher cells and benign lymphoid nodules were also seen.
Conclusion: Sequential analysis showed that Imatinib reduced the grade of myelofibrosis significantly (p-value< 0.04). It also prevented development of myelofibrosis in patients who did not have it at presentation. Hence Imatinib is effective when used early in the course of CML-CP
Bone marrow morphology, Imatinib mesylate, Myelofibrosis, Myeloproliferative neoplasms, Philadelphia chromosome
Neha Chopra Narang, Usha Rusia, Meera Sikka, Mrinalini Kotru. MORPHOLOGICAL CHANGES IN BONE MARROW POST IMATINIB THERAPY IN CHRONIC PHASE CML: A FOLLOW UP STUDY ON SEQUENTIAL BONE MARROW ASPIRATES AND BIOPSIES. Journal of Clinical and Diagnostic Research [serial online] 2017 April [cited: 2017 May 29 ]; 11:EC25-EC29. Available from
Date of Submission: Nov 03, 2016
Date of Peer Review: Dec 11, 2016
Date of Acceptance: Jan 20, 2017
Date of Publishing: Apr 01, 2017
Financial OR OTHER COMPETING INTERESTS: None.
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