Bone Marrow in Megakaryocytic Disorders

Burkhardt, R.

doi:10.1016/s0889-8588(18)30592-6

Cited by 23 publications

(19 citation statements)

References 84 publications

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“…As shown by our bone marrow analyses, increased megakaryopoiesis with abnormal megakaryocytes was a characteristic feature in all stages of ET, also in cases lacking thrombocytosis (Burkhardt, 1988). The possible prospective diagnostic contribution of bone marrow examination in ET, in particular of histology, is supported by the fact, that in 97% of all ET patients and in 95% of early cases, pathologic megakaryopoiesis had already been described at primary evaluation, suggesting the diagnosis of ET.…”

Section: Discussionsupporting

confidence: 80%

“…But in the evaluation of the natural course of ET the exclusion of early stages with moderate thrombocytosis below the limit of 600 × 10 9 /l may lead to incomplete recognition of characteristic features of the disease. As reported previously (Burkhardt, 1988;Burkhardt et al, 1990;Thiele et al, 1988Thiele et al, , 1989Georgii et al, 1990), ET is characterized by typical patterns of bone marrow histology, in particular by abnormal megakaryopoiesis, even in cases with slight thrombocytosis. This may offer the possibility of identifying early cases of ET independent of the platelet count.…”

supporting

confidence: 68%

“…As described previously (Georgii et al, 1990;Thiele et al, 1996), pathologic megakaryocytes in ET frequently differ morphologically from those in other myeloproliferative disorders, including early hyperplastic stages of idiopathic myelofibrosis which is sometimes difficult to distinguish from ET. Moderately increased granulopoiesis and erythropoiesis can also be found in cases with a clinical course of ET (Burkhardt, 1988), as seen in some of our patients.…”

Section: Discussionmentioning

confidence: 99%

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Should a platelet limit of 600 × 10⁹/l be used as a diagnostic criterion in essential thrombocythaemia? An analysis of the natural course including early stages

Lengfelder

Hochhaus

Kronawitter³

et al. 1998

Br J Haematol

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120

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Summary. In order to evaluate the natural history of essential thrombocythaemia (ET), clinical data and prognostic factors of 143 patients with ET were retrospectively analysed (mean observation time 6·1 Ϯ 4·6 years). In 42 patients the early phase of the disease with initial platelet counts between 250 and 600 × 10 9 /l was assessed. In most early cases, ET was suggested by clinical symptoms (79%) and increased megakaryopoiesis (95%) with abnormal megakaryocytes in bone marrow histology (n ¼ 34) and cytology (n ¼ 5). Other myeloproliferative disorders and reactive thrombocytosis were excluded according to the diagnostic criteria of the Polycythemia Vera Study Group. During follow-up of the 38 early cases not treated cytoreductively at diagnosis, the platelet counts increased to >600 × 10 9 /l in 28 patients (74%) and remained between 450 and 600 × 10 9 /l in 10 patients (26%). In primarily asymptomatic patients (n ¼ 46) with initial platelet counts above (n ¼ 37) and below 600 × 10 9 /l (n ¼ 9) the rates of increase of symptomatic patients were similar at about 7% per year. No influence of the initial platelet count on survival was seen in multivariate analysis of prognostic factors which included all 143 cases. Survival was mainly influenced by the rate of ET-related complications during follow-up (P ¼ 0·002). Analysing the influence of cytoreductive therapy on symptom-free survival, platelet reduction benefited patients under 60 years (19 cytoreductively treated v 65 untreated patients, P ¼ 0·075). The results demonstrate the possible clinical relevance of the early stages of ET and suggest that the features of pathologic megakaryopoiesis in the bone marrow are a more reliable diagnostic criterion than a definite platelet limit. Therefore, further therapeutic studies should include all stages of the disease and all age groups.Keywords: myeloproliferative disorder, early essential thrombocythaemia, prognostic factors, diagnostic criteria, bone marrow histology.Due to the lack of a specific diagnostic marker, the diagnostic criteria of essential thrombocythaemia (ET) established by the Polycythemia Vera Study Group (PVSG) were directed primarily at the exclusion of other myeloproliferative disorders and of reactive thrombocytosis. For diagnosis of ET, a platelet count of 600 × 10 9 /l was considered as an absolute requirement (Murphy et al, 1986). For protocols involving myelosuppressive agents a platelet count of 1000 × 10 9 /l was determined to restrict the erroneous inclusion of cases with reactive thrombocytosis and to avoid possible overtreatment of cases with a mild course of ET (Murphy et al, 1986(Murphy et al, , 1997. In most of the following studies, patients with lower platelet counts were excluded according to the criteria of the PVSG. Such selectivity is acceptable for therapeutic studies. But in the evaluation of the natural course of ET the exclusion of early stages with moderate thrombocytosis below the limit of 600 × 10 9 /l may lead to incomplete recognition of characteristic features of the di...

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Section: Discussionsupporting

confidence: 80%

supporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Should a platelet limit of 600 × 10⁹/l be used as a diagnostic criterion in essential thrombocythaemia? An analysis of the natural course including early stages

Lengfelder

Hochhaus

Kronawitter³

et al. 1998

Br J Haematol

Self Cite

120

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“…Helicobacter pylori ( H. pylori) infection was assessed by the 13 C urea breath test. To eradicate H. pylori, lansoprazole (30 mg twice daily), clarithromycin (200 mg twice daily), and amoxicillin (750 mg twice daily) were given for 7 days.…”

Section: Helicobacter Pylori Eradicationmentioning

confidence: 99%

“…Spontaneous CR and PR without treatment occurred in 3 and 4 patients, respectively. Twentysix patients underwent the 13 C urea breath test. Results of the 13 C urea breath test and H. pylori eradication was shown in Table 1.…”

Section: Treatments Of Itpmentioning

confidence: 99%

Prediction of Clinical Outcome in Patients with Idiopathic Thrombocytopenic Purpura by Evaluating Bone Marrow Clot CD20+ B Lymphocytes and Morphological Changes of Megakaryocytes

Yamamoto

Narimatsu

Ito

et al. 2008

J Clin Exp Hematopathol

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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 ( ≧ 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. 〔J Clin Exp Hematopathol 48(1) : 11-15, 2008〕

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Prognostic factors in idiopathic (Primary) osteomyelofibrosis

Kvasnicka

Thiele

Werden

et al. 1997

Cancer

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Bone Marrow in Megakaryocytic Disorders

Cited by 23 publications

References 84 publications

Should a platelet limit of 600 × 10⁹/l be used as a diagnostic criterion in essential thrombocythaemia? An analysis of the natural course including early stages

Should a platelet limit of 600 × 10⁹/l be used as a diagnostic criterion in essential thrombocythaemia? An analysis of the natural course including early stages

Prediction of Clinical Outcome in Patients with Idiopathic Thrombocytopenic Purpura by Evaluating Bone Marrow Clot CD20+ B Lymphocytes and Morphological Changes of Megakaryocytes

Prognostic factors in idiopathic (Primary) osteomyelofibrosis

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Bone Marrow in Megakaryocytic Disorders

Cited by 23 publications

References 84 publications

Should a platelet limit of 600 × 109/l be used as a diagnostic criterion in essential thrombocythaemia? An analysis of the natural course including early stages

Should a platelet limit of 600 × 109/l be used as a diagnostic criterion in essential thrombocythaemia? An analysis of the natural course including early stages

Prediction of Clinical Outcome in Patients with Idiopathic Thrombocytopenic Purpura by Evaluating Bone Marrow Clot CD20+ B Lymphocytes and Morphological Changes of Megakaryocytes

Prognostic factors in idiopathic (Primary) osteomyelofibrosis

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Should a platelet limit of 600 × 10⁹/l be used as a diagnostic criterion in essential thrombocythaemia? An analysis of the natural course including early stages

Should a platelet limit of 600 × 10⁹/l be used as a diagnostic criterion in essential thrombocythaemia? An analysis of the natural course including early stages