Prediction of clinical outcome in patients with idiopathic thrombocytopenic purpura by evaluating bone marrow clot CD20+ B lymphocytes and morphological changes of megakaryocytes.
The pathology of B-lymphocytes in the bone marrow of patients with idiopathic thrombocytopenic purpura (ITP) has not been well described, even though B-lymphocytes may be involved in the etiology of ITP. We retrospectively reviewed the medical records of 73 ITP patients between January 1997 and June 2005 with platelet counts of < 50 x 10(9)/L. Bone marrow clots were available for pathological review in 56 patients who were classified into 3 groups based on the results of the bone marrow clot examination : Group A (21 patients) had increased CD20+ lymphocytes (> or =1% of nucleated cells) and megakaryocytes with morphologic changes ; Group B (21 patients) had morphologic changes but no increase in CD20+ lymphocytes ; and Group C (14 patients) had neither morphologic changes nor increased CD20+ lymphocytes. Multivariate analysis showed that, compared to Group A, Group B had a significant prognostic factor (p = 0.04 ; odds ratio, 6.65 ; 95% confidence interval, 1.09 to 40.54) for achieving complete response, while Group C had a significant prognostic factor for any treatment response (p = 0.04 ; odds ratio, 14.26 ; 95% confidence interval, 1.08 to 188.02). Thus, ITP patients can be classified with different clinical outcomes based on immunohistopathological examination of bone marrow clots.
Yamamoto
Fumiko
F
Department of Hematology and Oncology, Toyohashi Municipal Hospital, Toyohashi, Japan.
Narimatsu
Hiroto
H
Ito
Masafumi
M
Yamashita
Satoshi
S
Kurahashi
Shingo
S
Sugimoto
Takumi
T
Adachi
Tatsuya
T
Sugiura
Isamu
I
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018951:Antigens, CD20 / Q000378:metabolism; D016175:B-Lymphocyte Subsets / Q000473:pathology*; D001402:B-Lymphocytes / Q000473:pathology*; D001854:Bone Marrow Cells / Q000473:pathology*; D005260:Female; D016481:Helicobacter Infections / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008533:Megakaryocytes / Q000473:pathology*; D008875:Middle Aged; D011379:Prognosis; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000145:classification* / Q000382:microbiology / Q000473:pathology*; D012189:Retrospective Studies
D018951:Antigens, CD20