Acute Megakaryoblastic Leukemia: Importance of Bone Marrow Biopsy in Diagnosis

Five cases of megakaryoblastic leukemia, presenting as “de novo” acute leukemias are reported. They represented 7.2% of all cases of adult acute non-lymphoblastic leukemias (ANLL) seen in our Hematology Service during the past 30 months. These cases showed features of predominantly blast proliferation with a marked increase of reticulin fibres in the bone marrow. One case had features of acute leukemia with trilineage myelodysplasia and one had a more chronic evolution with splenomegaly initially resembling a myeloproliferative syndrome. In all cases, the definitive diagnosis was made on bone marrow histology as cytology was poor and the blast cells were positive for factor VIII with the immunoperoxidase technique. The importance of bone marrow histology is emphasized.     

Bone Marrow Biopsy Changes in the Iliac Bone Mimicking Multiple Colonic Polypi

Many different entities simulating colonic polyps on barium enema examination have been described. Of the extraluminal mimics, round bony structures such as vertebral pedicles are perhaps best known. We describe the cause of a previously undescribed artifact: bone marrow biopsy of the ilium.     

Long-Term Bone Marrow Cultures Established from Bone Marrow Transplant Recipients

Following bone marrow transplantation (BMT), the stroma remains host-derived, and has therefore been exposed to the high doses of chemoradiotherapy used in BMT conditioning. We have used long term bone marrow culture (LTBMC) to study the effect of this conditioning therapy on the stroma. Twenty-five BMT recipients were studied, comprising 13 allografts and 12 autografts. Marrow was aspirated prior to transplant (6 cases) and at 3, 6 or 12 months post-BMT. Fifteen haematologically normal subjects were studied in parallel. The stromal layer of LTBMC was visually assessed at weekly intervals and supernatant cells counted and assayed for colony forming unit-granulocyte/macrophage (CFU-GM).

Five of the six cases studied both before and after BMT formed less confluent stroma following the procedure. A successive improvement in the proportion of patients forming good stroma was observed with increasing time from BMT. Supernatant cell and CFU-GM counts were not significantly different from normal following BMT. No clear relationship was observed between stromal confluence and any of the following: supernatant cell and CFU-GM counts, transplant type, underlying disease, conditioning regime or time to engraftment. These data support the view that BMT conditioning regimes cause stromal damage, and that this damage gradually improves with time.     

Impact of Day 14 Bone Marrow Biopsy on Re-Induction Decisions and Prediction of a Complete Response in Acute Myeloid Leukemia Cases

Background: With acute myeloid leukemia (AML), there are limited data about the accuracy of day 14 bone marrow (BM) biopsies for predicting complete remission as compared to day 28 BM biopsy results. We here aimed to estimate the correlation between, and the diagnostic accuracy of, both approaches. Materials and Methods: We reviewed 84 patients with AML treated with standard induction chemotherapy to evaluate the remission rate and treatment decisions based on day 14 BM biopsy from 2000-2012. Results: Sixty five patients (77%) demonstrated remission (CR) with less than 5% blasts on their day 14 BM. Thirteen patients (16%) had residual disease (RD), and 6 (7%) were classified as indeterminate response (IR) i.e., blasts 5-20%. Two patients with RD on day 14 underwent re-induction. Out of the 17 remaining cases with RD+IR, 14 (all 6 with IR and 8 out of 11 with residual disease with no re-induction) demonstrated a morphologic complete remission (CR) on day 28 BM. The percentages for complete remissions on days 28 and 14 were significantly different [94% versus 79.3%, respectively; p=0.004, (OR= 0.143, 95% CI: 0.032-0.63)]. Day 14 BM had 82% sensitivity in predicting CR on Day 28; however, it had insufficient specificity (60%) in predicting failure of CR. Conclusions: Induction treatment response assessment based on day 14 BM does not accurately predict the response rate on day 28 and the use of day 14 BM as a sole marker of response to therapy might expose patients to unnecessary interventions.     

Magnetic Resonance Imaging in Patients with Bone Marrow Disorders

Magnetic resonance imaging (MRI) provides a non-invasive means to evaluate a large fraction of marrow in less than one hour. Marrow disorders produce non-specific changes in marrow signal intensities which primarily reflect changes in proportions of fat and cellular elements. The pattern of these signal changes narrows the differential diagnosis, and the combination of these features with the clinical context allows interpretations which are clinically useful in many ways. These include: I) the diagnosis of avascular necrosis (and its distinction from other causes of joint pain), 2) detection of osteomyelitis, 3) differential diagnosis of hypo-plastic disorders, 4) staging of lymphomas and myeloma, 5) selection of patients for autolo-gous bone marrow transplant, 6) objective measures of marrow response to therapy, 7) detection of leukemic transformation, and 8) improved detection of marrow disease (primary or secondary) in patients with otherwise unexplained bone pain.     

Observation Versus Immediate Reinduction for Acute Myeloid Leukemia Patients With Indeterminate Day 14 Bone Marrow Results

IntroductionThe benefit of immediate reinduction chemotherapy for patients with indeterminate day 14 bone marrow results (≤ 20% cellularity and 5%-20% blasts) remains unclear. We report our experience with patients with acute myeloid leukemia (AML) with indeterminate day 14 bone marrow biopsy results treated with reinduction chemotherapy versus observation alone.Materials and MethodsWe performed a retrospective study to assess the outcomes of adult patients with newly diagnosed AML treated with or without reinduction chemotherapy for indeterminate day 14 bone marrow results.ResultsWe identified 50 patients with indeterminate day 14 bone marrow results. Of the 50 patients, 25 (50%) had received reinduction therapy and 25 (50%) had not. Of the 50 patients, 24 (48%) had poor risk disease, 12 in the reinduction arm (10 with an abnormal karyotype and 2 with a normal karyotype with molecular abnormalities) and 12 in the observation arm (6 with an abnormal karyotype and 6 with a normal karyotype with molecular abnormalities). The overall response rate (complete remission plus complete remission with incomplete count recovery) was similar in both treatment arms (80% vs. 80%). No statistically significant difference was found in the median overall survival (13 months vs. 21 months; P = .88) or relapse-free survival (13 months vs. 33 months; P = .53) between the 2 treatment arms.ConclusionOur study did not find a statistically significant difference in the overall response rates or survival outcome measures for patients with AML and indeterminate day 14 bone marrow in the 2 treatment groups. Our findings question the utility of immediate reinduction chemotherapy and raise concern regarding overtreatment in this patient population. Larger studies investigating similar outcomes are warranted to validate our clinical findings.     

骨髓活检在骨髓增生异常综合征诊断中的意义(附97例分析)

目的：探讨骨髓活组织检查对于诊断骨髓增生异常综合征(MDS)的意义。方法：对97例MDS患者进行髂前上棘或髂后上棘取材，塑料包埋、切片，用HGF或改良HGE染色，网硬蛋白采用嗜银纤维染色。结果：MDS患者骨髓活组织切片增生极度活跃者16例，增生明显活跃者52例，增生活跃者29例，造血组织所占比例为36％～90.5％；幼红细胞岛检出率79.4％(77例)；ALIP检出率97.9％(95例)，其中5个以上的簇或成堆前体细胞的异常定位占25.3％(24例，肝脏和／或脾脏、淋巴结相对肿大明显)；微巨核细胞检出率96.9％(94例)；伴纤维组织增生者25例(占25.8％)；淋巴细胞、浆细胞、网状细胞等非造血细胞均有不同程度浸润；有基质出血、水肿者16例(占16.5％)。结论：骨髓活组织检查对于骨髓增生异常综合征(MDS)的阶段划分直观、明了，尤其在骨髓干抽病例更有其优越性；临床上对于其中5个以上的簇或成堆前体细胞的异常定位病例应个体化给予常规化疗。     

Cell Suspensions from Collagenase Digestion of Bone Marrow Trephine Biopsy Specimens—its Use in Lymphoma

Collagenase digestion allows cells to be released into suspension from bone marrow tissue. Discrete abnormal populations of lymphoid cells can be identified by cell morphology and immunological phenotyping techniques. Viable cells are also available for chromosomal analysis. This technique makes cells available for analysis in cases of dry bone marrow taps and has a particular use in the investigation of bone marrow involvement by malignant lymphoma.     

A Randomized Trial of Hypnosis for Relief of Pain and Anxiety in Adult Cancer Patients Undergoing Bone Marrow Procedures

Pain and anxiety are closely associated with bone marrow aspirates and biopsies. To determine whether hypnosis administered concurrently with the procedure can ameliorate these morbidities, the authors randomly assigned 80 cancer patients undergoing bone marrow aspirates and biopsies to either hypnosis or standard of care. The hypnosis intervention reduced the anxiety associated with procedure, but the difference in pain scores between the two groups was not statistically significant. The authors conclude that brief hypnosis concurrently administered reduces patient anxiety during bone marrow aspirates and biopsies but may not adequately control pain. The authors explain this latter finding as indicating that the sensory component of a patient's pain experience may be of lesser importance than the affective component. The authors describe future studies to clarify their results and address the limitations of this study.     

Bone Marrow Involvement in Lymphoma: The Importance of Marrow Magnetic Resonance Imaging

Detection of bone marrow involvement is important for staging and treatment decisions in patients with lymphoma. Although routine bone marrow evaluation is based on aspirates and bone marrow biopsies, new diagnostic tools are required to improve diagnostic accuracy. Visual and quantitative assessment of the bone marrow by magnetic resonance (MR) imaging is useful for the detection of occult lymphomatous marrow involvement. MRI is also suitable for the evaluation of disease extent in the bone marrow. Furthermore, abnormal images on marrow MRI may be associated with a significantly poorer survival in patients with lymphoma, regardless of histologic findings in the marrow. Evaluation of the bone marrow by MRI is essential to assess disease status in patients with lymphoma.     

应用激活骨髓净化肿瘤细胞的研究

应用国产白介素２（ＩＬ－２）与骨髓细胞共同孵育１或３天，产生激活骨髓（分别记为ＡＢＭ１或ＡＢＭ３）。用３Ｈ－ＴｄＲ释放法测定，表明ＡＢＭ对肿瘤细胞株ＡＧＺＹ－８３ａ和ＣＥＭ具有明显杀伤活性。ＡＢＭ３抗瘤活性明显高于ＡＢＭ１，而新鲜骨髓或单用ＩＬ－２不具有明显抗肿瘤活性。ＡＢＭ可以净化自身骨髓中的ＣＥＭ细胞（效／靶为５０／１），而ＡＢＭ与对照组骨髓比较粒单集落形成率无统计学差别，提示ＡＢＭ仍然保持其造血活性。本文结果初步提示ＡＢＭ可用于净化骨髓中肿瘤细胞之目的。     

Myelodysplastic Syndrome Associated with Bone Marrow Fibrosis

Bone marrow biopsy (BMB) in myelodysplastic syndrome (MDS) frequently reveals a slight alteration in the reticulin stroma which does not have any clinical significance. However, in a minority of cases, full-blown bone marrow fibrosis (BMF) can be found.

Primary MDS patients with BMF show distinct clinico-pathological features and an unfavourable prognosis mainly attributable to complications deriving from pancytopenia and continuous transfusions, while leukemic transformation occurs only rarely. Since BMF may characterize other hematological disorders, primary MDS with BMF should be included in the differential diagnosis particularly with malignant myelofibrosis (MM) and idiopathic myelofibrosis (IMF).

Secondary MDS with BMF represent a variety of preleukemic conditions in subjects treated for previous neoplasias. Unlike the primary forms, they do not form a clearcut clinico-pathological entity.     

不同骨髓检查在淋巴瘤诊断中的价值

探讨3种骨髓检查方法（骨髓涂片、活检、流式细胞术分析）对淋巴瘤骨髓浸润的诊断及分期价值。方法：对74例患者进行3种方法的骨髓检查,评估不同方法的检出率、对分期的影响以及各亚型中骨髓浸润的风险。结果：骨髓涂片阳性者12例（16.2%）,骨髓活检阳性10例（13.5%）,流式细胞术分析阳性23例（31.1%）,流式细胞术分析的阳性率显著高于涂片和活检检查（P<0.05）;骨髓涂片、活检、流式细胞术分析可互相修正淋巴瘤患者的临床分期;弥漫大B细胞淋巴瘤亚型骨髓浸润比例最高;对于无淋巴结、肝脾肿大者,骨髓检查具有明确诊断的作用。结论：骨髓涂片、活检及流式细胞术分析对淋巴瘤有重要的诊断及分期价值,三者互为补充,不能相互替代。     

Basosquamous Basal Cell Carcinoma with Bone Marrow Metastasis

Basal cell carcinoma (BCC) is the most common cancer in Caucasians. It is slow growing and rarely metastasizes. If left untreated over time, invasive growth can occur. We present a patient case with a primary BCC located in the right sub-mammary area, with extensive metastases to the skeleton and bone marrow. Histopathological examination of the tumour showed BCC with a diverse growth pattern. There were no signs of local metastases. Surgery was successfully performed. Three months post-surgery the patient developed normocytic anaemia and elevated inflammation markers. [¹⁸F]FDG PET/CT showed extensive FDG uptake in the entire skeleton and bone marrow. Biopsy confirmed the infiltration of BCC with similar histopathological features as the primary tumour. Prognosis of metastasized BCC is poor and, therefore, long-term follow-up of patients with risk factors is of importance.     

Prognostic Factors in Adult Patients with Solid Cancers and Bone Marrow Metastases

Background: Solid cancers with bone marrow metastases are rare but lethal. This study aimed to identifyclinical factors predictive of survival in adult patients with solid cancers and bone marrow metastases. Methods:A total of 83 patients were enrolled consecutively between January 1, 2000 and December 31, 2012. Bonemarrow metastases were confirmed by biopsies. Patient clinical features and laboratory data were analyzed forassociations. Results: The median age of the patients was 54 years (range, 23–88 years), and 58% were male. The3 most common primary tumor locations were the stomach (32 patients, 39%), prostate (16 patients, 19%), andlungs (12 patients, 15%). The median overall survival was 49 days (range, 3–1423 days). Patients with EasternCooperative Oncology Group performance status 1, cancers of prostate origin, platelet counts over 50,000/ml,and undergoing antitumor therapies had a significantly better prognosis in the multivariate analysis. The mediansurvival times were 173 and 33 days for patients with 2-3 more favorable parameters (n=24) and those with0-1 (n=69), respectively (hazard ratio 0.30; 95% CI 0.17-0.52, p<0.001). Conclusions: Solid cancers with bonemarrow metastases are dismal and incurable diseases. Understanding prognostic factors to these diseases helpsmedical personnel to provide appropriate treatments and better inform patients about outcomes. Antitumortherapies may improve outcomes in selected patient cohorts.     

非霍奇金淋巴瘤侵犯骨髓的病理形态及免疫表型特点分析

目的:探讨非霍奇金淋巴瘤(NHL)侵犯骨髓的病理形态、免疫表型特点.方法:对骨髓活检标本,石蜡包埋切片,HE染色,光镜观察形态免疫组化进行表型分析.结果:65例中,B细胞淋巴瘤39例,T细胞淋巴瘤26例.形态学上,B细胞淋巴瘤多以混合型、弥漫型侵犯为主,外周T细胞淋巴瘤(PTCL)以间质型、混合型侵犯多见,伴有浆细胞、嗜酸细胞等反应性成分.毛细胞白血病(HCL)呈蜂窝样外观,具有诊断特异性.26例有髓外原发淋巴瘤者,瘤细胞形态与相应骨髓活检形态一致.免疫组化可对大部分淋巴瘤分型.6例小B细胞淋巴瘤不能分型的,2例结合脾脏病理特点确诊,4例仅有骨髓活检标本的,有待进一步检查确定.结论:多数NHL骨髓侵犯具有明确的形态学及免疫表型特点,可以诊断并分型.少数需结合原发部位及其它检查确诊.     

Bone Marrow Transplantation for Acute Non-Lymphoblastic Leukemia

Most results obtained by different study and analytic designs favor that matched allogeneic BMT is superior to chemotherapy in young adults with ANLL in first remission. The place of ABMT is more difficult to assess and requires further study both compared to chemotherapy and allogeneic BMT. Furthermore, the question of purging needs further study in a controlled fashion. For older patients the choice is more difficult. Transplant related mortality increases with age which makes ABMT an attractive alternative to allogeneic BMT. However, recent advances in prophylaxis and treatment of transplant related complications such as cytomegalovirus interstitial pneumonia and veno-occlusive disease of the liver might increase long-term survival after allogeneic BMT in older patients. The role of matched unrelated donors in the treatment of ANLL is unresolved but this procedure should probably be reserved for relatively young patients in second complete remission or later.     

流式细胞术和形态学同步分析NHL骨髓侵犯的临床意义

目的探讨临床检测ＮＨＬ骨髓侵犯的意义。方法应用流式细胞术和细胞形态学方法,同步分析３４例ＮＨＬ骨髓侵犯程度。结果①流式细胞术检测ＮＨＬ患者骨髓细胞ＤＮＡ异倍体率为６１８％（２１／３４）,形态学分析ＢＭＩ（＋）率为１７７％（６／３４）,二法联检阳性率可达６４７％;②随患者临床分期增高,ＢＭＩ（＋）率也逐渐增加;ＢＭＩ（＋）者的Ｓ期细胞比率显著高于ＢＭＩ（－）者（Ｐ＜００１）;③化疗后,ＮＨＬ患者骨髓细胞细胞凋亡水平明显升高（Ｐ＜００１）,ＤＮＡ异倍体率和ＳＰＦ均有所降低。结论流式细胞术和形态学同步分析可提高ＮＨＬ患者骨髓侵犯的阳性检测率,以评价肿瘤恶性度和化疗疗效;肿瘤化疗的重要机制之一,是药物诱导细胞凋亡。     

骨髓转移癌的临床与实验室特征

本文对1984年至1991年间我院所见14例骨髓转移癌的临床及实验室特征进行了分析报道。发现本组女多于男(男:女=1:1.8).且女性发病年龄较轻。剧烈骨痛、高热、贫血、出血;骨压痛与骨髓有核细胞增生低下足常见的临床与实验室表现。所有病例经骨髓涂片和(或)骨髓活检均发现癌细胞。8例找到原发灶,其中4例为胃粘液腺癌,2例前列腺癌,另2例分别为肺癌及肝癌。本文对如何提高本病的确诊率进行了讨论。