title: Bone marrow fibrosis in childhood acute lymphoblastic leukemia correlates to biological factors, treatment response and outcome.
abstract: We retrospectively evaluated reticulin fiber density (RFD) in 166 diagnostic bone marrow (BM) biopsies and 62 biopsies obtained at treatment day 29 from children with acute lymphoblastic leukemia (ALL). Patients with B-cell precursor (BCP)-ALL showed higher RFD as compared to patients with T-cell ALL (P<0.001). RFD correlated negatively with white blood cell count (P=0.008) in BCP-ALL patients. Patients with high-hyperdiploid ALL (51-61 chromosomes), no high-risk criteria and low RFD showed a favorable outcome when compared to similar patients with high RFD (P=0.002). In BCP-ALL patients, RFD at diagnosis correlated to the levels of minimal residual disease (MRD) analyzed by flow cytometry on treatment day 29 (P=0.001). Accordingly, patients with MRD > or = 10(-4) presented higher RFD at diagnosis compared to patients with MRD < 10(-4) (P=0.003). BCP-ALL patients with low RFD at diagnosis and a rapid reduction of RFD on day 29 had a favorable outcome compared to patients with the same baseline RFD level at diagnosis but a slow RFD reduction (P=0.041). To our knowledge, these findings are novel and may indicate BM fibrosis as a new valuable prognostic marker in childhood ALL. Expanded use of BM biopsy both at diagnosis and during follow-up is suggested.
authors: Department of Clinical Sciences, Pediatrics, Umea University, Umea, Sweden. ulrika.norennystrom@pediatri.umu.se
authors: U
authors: U
authors: Norén-Nyström
authors: G
authors: G
authors: Roos
authors: A
authors: A
authors: Bergh
authors: J
authors: J
authors: Botling
authors: G
authors: G
authors: Lönnerholm
authors: A
authors: A
authors: Porwit
authors: M
authors: M
authors: Heyman
authors: E
authors: E
authors: Forestier
mesh_terms: D000293:Adolescent; D000782:Aneuploidy; D001706:Biopsy; D001856:Bone Marrow Examination; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000473:pathology / Q000628:therapy; D008297:Male; D018365:Neoplasm, Residual; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000473:pathology / Q000628:therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000145:classification / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D055728:Primary Myelofibrosis / Q000209:etiology / Q000473:pathology*; D011379:Prognosis; D012155:Reticulin / Q000032:analysis*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D012155:Reticulin