title: Significance of bone marrow reticulin fibrosis in chronic lymphocytic leukemia at diagnosis: a study of 176 patients with prognostic implications.
abstract: BACKGROUND
  Bone marrow (BM) biopsies from patients with chronic lymphocytic leukemia (CLL) may show reticulin fibrosis at diagnosis, but its significance remains unclear. This study sought to assess the prognostic impact of BM reticulin fibrosis in patients with previously untreated CLL.
  
  
  METHODS
  Data was reviewed from untreated CLL patients in the national Israel CLL database, followed during 1987 to 2012. All bone marrow biopsies were graded for reticulin fibrosis using a modified scoring system containing 4 grades (0-3), based on the European consensus report. Grade of reticulin fibrosis was correlated with overall survival (OS), outcome, and a number of well-recognized prognostic factors for CLL.
  
  
  RESULTS
  The final cohort included 176 patients (122 males and 51 females). Median age was 63 years (range, 32-86 years) and the 5-year OS was 77.1%. Grade of BM reticulin fibrosis correlated with OS (P < .0001) and mortality (P = .001), and separated patients into 2 groups with different survival curves. Advanced reticulin fibrosis (grades 2-3) was associated with thrombocytopenia (platelet counts of < 100,000/mm(3) ) (P = .025), anemia (P = .018), elevated β2-microglobulin < 4000 μg/mL (P = .048), and the presence of 11q deletion (P = .0015).
  
  
  CONCLUSIONS
  There was a significant correlation between poor survival and grade of BM reticulin fibrosis. This staining procedure is easy to perform and can readily be added routinely when examining BM biopsies in CLL, because the findings do have prognostic implications.
authors: Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel. tamar.tadmor@b-zion.org.il
authors: Tamar
authors: T
authors: Tadmor
authors: Lev
authors: L
authors: Shvidel
authors: Ariel
authors: A
authors: Aviv
authors: Rosa
authors: R
authors: Ruchlemer
authors: Osnat
authors: O
authors: Bairey
authors: Mona
authors: M
authors: Yuklea
authors: Yair
authors: Y
authors: Herishanu
authors: Andre
authors: A
authors: Braester
authors: Naomi
authors: N
authors: Rahimi-Levene
authors: Naomi
authors: N
authors: Levene
authors: Fiona
authors: F
authors: Vernea
authors: Jonathan
authors: J
authors: Ben-Ezra
authors: Jacob
authors: J
authors: Bejar
authors: Aaron
authors: A
authors: Polliack
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000150:complications; D001853:Bone Marrow / Q000737:chemistry / Q000473:pathology*; D001856:Bone Marrow Examination; D002880:Chromosomes, Human, Pair 11; D004396:Coloring Agents; D005260:Female; D017353:Gene Deletion; D006801:Humans; D007557:Israel / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications* / Q000401:mortality / Q000473:pathology*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D010976:Platelet Count; D011237:Predictive Value of Tests; D055728:Primary Myelofibrosis / Q000175:diagnosis*; D011379:Prognosis; D016016:Proportional Hazards Models; D012155:Reticulin; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016622:Silver Staining / Q000379:methods; D013921:Thrombocytopenia / Q000097:blood / Q000150:complications; D001613:beta 2-Microglobulin / Q000097:blood
chemical_list: D004396:Coloring Agents; D012155:Reticulin; D001613:beta 2-Microglobulin