Various treatment responses in Imatinib treated CML patients with emphasis on marrow profile: a descriptive study in a tertiary care centre in South India
Keywords:
hematological and cytogenetic response, marrow response
Abstract
Background: CML is a clonal stem cell neoplasm characterised by reciprocal translocation between chromosomes 9 and 22.Imatinib is used in its treatment which induces hematological, cytogenetic and molecular response. Yet, marrow response is less well defined than hematological and cytogenetic response (HR and CR). Hence our aims were1.To study the hematologic response in CML patients after 3 months of Imatinib2.To study the cytogenetic response in CML patients after 6 months of Imatinib. 3.To study and categorize morphological changes in marrow at the end of three months of treatment. Materials and methods: Forty six newly diagnosed patients of CML (BCR-ABL positive), irrespective of phase, were included. HR and CR was evaluated at the end of three months and six months of Imatinib therapy, respectively. A bone marrow aspirate and biopsy was performed at the end of three months, marrow responses were classified and parameters were analysed.Results: Of 46 patients, 91.3% of patients attained complete hematological response.30/46 patients had a follow up FISH analysis at 6 months, of whom 70% attained complete cytogenetic response(table/figure 3). Twenty nine (64.5%) of the post treatment aspirates were diluted and imprints/biopsy yielded information. Twenty eight (63%) patients showed marrow normalization, eleven (23%) persistence of disease, four (8%) progression of disease to blast crisis (BC) and three (6.5%) hypo cellular marrow.Conclusion: Post therapy BM in CML, when undertaken should have biopsy rather than an aspirate alone, as aspirates are often diluted and biopsy may yield useful information like impending blast crisis.DOI: 10.21276/APALM.1514References
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15. Bueso-Ramos CE, Cortes J, Talpaz M, O’Brien S, Giles F, Rios MB, et al. Imatinib mesylate therapy reduces bone marrow fibrosis in patients with chronic myelogenous leukemia. Cancer. 2004 Jul 15;101(2):332–6.
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2. Deininger MWN, Druker BJ. Specific Targeted Therapy of Chronic Myelogenous Leukemia with Imatinib. Pharmacol Rev 2003;55:401–23.
3. Lugli A, Ebnoether M, Cogliatti SB,Gratwohl A, Passweg J, Hess U et al. Proposal of a morphologic bone marrow response score for imatinib mesylate treatment in chronic myelogenousleukemia. Hum Pathol 2005;36:91–100.
4. Srinivas BH, Paul TR, Uppin SG, Uppin MS, Jacob RT, Raghunadharao D. Morphologic Changes in the Bone Marrow in Patients of Chronic Myeloid Leukemia (CML) Treated with ImatinibMesylate. Indian J Hematol Blood Transfus 2012;28:162–9.
5. Joshi S, Sunita P, Deshmukh C, Gujral S, Amre P, Nair CN. Bone marrow morphological changes in patients of chronic myeloid leukemia treated with imatinib mesylate. Indian J Cancer 2008;45:45–9.
6. Razmkhah F, Razavi M, Zaker F, Kazemi A, Negari S, Rasighaemi P et al. Hematologic and Molecular Responses to Generic Imatinib in Patients With Chronic Myeloid Leukemia. Lab Med 2010;41:547-50.
7. Kantarjian HM, O’Brien S, Cortes JE, Smith TL, Rios MB, Shan J et al. Treatment of Philadelphia chromosome-positive, accelerated-phase chronic myelogenous leukemia with imatinib mesylate. Clin Cancer Res 2002;8:2167–76.
8. Khonglah Y, Basu D, Dutta TK. Bone marrow trephine biopsy findings in chronic myeloid leukemia. Malays J Pathol. 2002 Jun;24(1):37-43.
9. Korkolopoulou P, Viniou N, Kavantzas N, Patsouris E, Thymara I, Pavlopoulos PM, et al. Clinicopathologic correlations of bone marrow angiogenesis in chronic myeloid leukemia: a morphometric study. Leukemia. 2003 Jan;17(1):89–97.
10. Paul TR, Uppin SG, Uppin MS, Jacob RT, Rao DR, Rajappa SJ. Evaluation of Cytopenias Occurring in Imatinib Treated Chronic Myeloid Leukemia (CML) Patients. Indian J Hematol Blood Transfus 2010;26:56–61.
11. Hasserjian RP, Boecklin F, Parker S, Chase A, Dhar S, Zaiac M et al. STI571 (imatinibmesylate) reduces bone marrow cellularity and normalizes morphologic features irrespective of cytogenetic response. Am J ClinPathol 2002;117:360–7.
12. Chavan D, Ahmad F, Iyer P,Dalvi R, Kulkarni A, Mandava S et al. Cytogenetic investigation in chronic myeloid leukemia: study from an Indian population. Asian Pac J Cancer Prev 2006;7:423.
13. Braziel RM, Launder TM, Druker BJ, Olson SB, Magenis RE, Mauro MJ et al.Hematopathologic and cytogenetic findings in imatinib mesylate-treated chronic myelogenous leukemia patients: 14 months’ experience. Blood 2002;100:435–41.
14. El-Zimaity MMT, Kantarjian H, Talpaz M, O’Brien S, Giles F, Garcia-Manero G, et al. Results of imatinib mesylate therapy in chronic myelogenous leukaemia with variant Philadelphia chromosome. Br J Haematol. 2004 Apr 1;125(2):187–95.
15. Bueso-Ramos CE, Cortes J, Talpaz M, O’Brien S, Giles F, Rios MB, et al. Imatinib mesylate therapy reduces bone marrow fibrosis in patients with chronic myelogenous leukemia. Cancer. 2004 Jul 15;101(2):332–6.
16. Lichtman MA, Williams WJ. Williams hematology. New York: McGraw-Hill, Medical Pub. Division; 2006.
17. Pruneri G, Bertolini F, Soligo D, Carboni N, Cortelezzi A, Ferrucci PF, et al. Angiogenesis in myelodysplastic syndromes. Br J Cancer. 1999;81(8):1398.
18. Aguayo A, Kantarjian H, Manshouri T, Gidel C, Estey E, Thomas D, et al. Angiogenesis in acute and chronic leukemias and myelodysplastic syndromes. Blood. 2000 Sep 15;96(6):2240–5.
Published
2018-01-27
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