Chronic Myeloproliferative Disorders in Bone Marrow Biopsies

Georgii, A.; Vykoupil, K. F.; Buhr, T.; Choritz, H.; Döhler, U.; Kaloutsi, V.; Werner, Martin

doi:10.1016/s0344-0338(11)81008-3

Cited by 123 publications

(197 citation statements)

References 68 publications

Supporting

Mentioning

189

Contrasting

Order By: Relevance

“…As has been demonstrated in this observational clinicopathological study, repeatedly performed BM trephines lend further support to the fact that only a fraction (about 35%) of the total series was compatible with (true) ET. Considering these findings and previous clinical [11,32,33] and morphological data [6,7,13,30,34,39,40] as well as cell culture studies [41][42][43], the WHO criteria [12] should be slightly modified by defining a lower limit of the platelet count. Finally, when comparing the diagnostic implications of histopathology with that of colony assays, one has to keep in mind that cell culture studies are burdensome and time-consuming and that interpretations are limited to an experienced observer in this speciality.…”

Section: Discussionmentioning

confidence: 99%

Follow‐up examinations including sequential bone marrow biopsies in essential thrombocythemia (ET): A retrospective clinicopathological study of 120 patients

et al. 2002

View full text Add to dashboard Cite

Diagnosis of essential thrombocythemia (ET) has been usually established by regarding the criteria of the Polycythemia Vera Study Group. Accordingly, a retrospective clinicopathological study was performed on 120 patients with a follow-up ranging between 5 and 13 years and repeated bone marrow trephine examinations. Following the new WHO classification, at presentation patients revealed three distinctive patterns of bone marrow (BM) features: (true) ET in 43 patients, prefibrotic idiopathic myelofibrosis (IMF) in 50 patients, and early IMF in 27 patients. Heterogeneity of morphological features was associated with correspondingly expressed laboratory data. Contrasting initial and early IMF, patients with true ET displayed an about 80% probability to lack splenomegaly, anemia, and increase in the LDH and LAP values and also failed to show any myeloblasts or erythroblasts on the peripheral blood films. Follow-up examinations including sequential BM biopsies (mean interval 39 ± 31 months) disclosed that of the 43 patients with true ET only one developed an increase in reticulin. On the other hand, 65 of 77 patients with prefibrotic and early IMF evolved into overt myelofibrosis-osteosclerosis. Moreover, survival analysis demonstrated significant differences in our patients. A neglectable proportion of life loss according to a sex-and age-matched general population was found in true ET (less than 11%) opposed to IMF without or mild fibrosis (range 21% to 32%). Am.

show abstract

Section: Discussionmentioning

confidence: 99%

Follow‐up examinations including sequential bone marrow biopsies in essential thrombocythemia (ET): A retrospective clinicopathological study of 120 patients

et al. 2002

View full text Add to dashboard Cite

show abstract

“…Michiels et al and the German pathologists Georgii and Thiele recognized that small mono-or bi-nucleated megakaryocytes are diagnostic for the Ph-positive diseases ET and CML. In contrast, large megakaryocytes with hyper-lobulated nuclei are pathognomonic for Ph-negative essential thrombocythemia (Figures 1 and 2) [13][14][15][16][17][18][19][20][21][22][23][24]. The Hannover Bone Marrow Classification of CML and MPD regarded myelofibrosis (MF) as a reactive secondary feature of myeloproliferative disease.…”

Section: The Hannover Bone Marrow Classification Of CML and The Mpds mentioning

confidence: 99%

“…The Hannover Bone Marrow Classification of CML and MPD regarded myelofibrosis (MF) as a reactive secondary feature of myeloproliferative disease. The terms agnogenic myeloid metaplasia (AMM), myeloid metaplasia with myelofibrosis (MMM), and chronic idiopathic myelofibrosis (CIMF) and primary myelofibrosis (PMF) lack accuracy because it is applied to both the early prefibrotic hypercellular stage and the advanced fibrotic stages [15,16]. Secondary MF in ET, PV and CMGM is classified as reticulin fibrosis (RF) grade 0 and 1 (=MF 0), RF grade 2 (=MF 1), RF 3 with minor collagen fibrosis (=MF 2) and advanced reticulin-collagen fibrosis (RCF) with or without osteosclerosis (=MF 3) [17,18].…”

Section: The Hannover Bone Marrow Classification Of CML and The Mpds mentioning

confidence: 99%

“…Secondary MF in ET, PV and CMGM is classified as reticulin fibrosis (RF) grade 0 and 1 (=MF 0), RF grade 2 (=MF 1), RF 3 with minor collagen fibrosis (=MF 2) and advanced reticulin-collagen fibrosis (RCF) with or without osteosclerosis (=MF 3) [17,18]. In the Hannover Bone Marrow Classification the megakaryocytes in BRC/ABL-positive thrombocythemia and CML are small containing uni-or bi-lobulated nuclei (Figures 1 and 2) but large and mature with hyperlobulated nuclei in ET [16][17][18][19][20][21][22][23][24][25][26]. The megakaryocytes in trilinear PV are of medium size to large (pleomorphic) with hyperploid nuclei.…”

Section: The Hannover Bone Marrow Classification Of CML and The Mpds mentioning

confidence: 99%

“…Prefibrotic CMGM is dominated by primary megakaryocyticgranulocytic myeloproliferation (PMGM) and increase of clustered atypical dysmorphic megakaryocytes due to increases of cellular and nuclear sizes. In CMGM/PMGM, the nuclei of dysmorphic megakaryocytes are bulky with clumsy lobuli and irregular roundish shaped form (so-called cloud-like nuclei), which are never seen in ET, PV and CML [16][17][18][19][20][21][22][23][24][25][26]. CMGM/PMGM is not preceded or followed by normocellular ET, PV or MDS and can be regarded as the third distinct prefibrotic primary MPD (Table 1) [19][20][21][22][23][24][25][26][27][28][29].…”

Section: The Hannover Bone Marrow Classification Of CML and The Mpds mentioning

confidence: 99%

See 2 more Smart Citations

Bone Marrow Features and Natural History of BCR/ABL-Positive Thrombocythemia and Chronic Myeloid Leukemia Compared to BCR/ABLNegative Thrombocythemia in Essential Thrombocythemia and Polycythemia Vera

Michiels¹

2015

J Hematol Thrombo Dis

View full text Add to dashboard Cite

The Hannover bone marrow (BM) classification distinguished three phenotypes of BCR/ABL-positive CML: CML of common type (CML.CT), CML with megakaryocyte increase (CML.MI) and CML with megakaryocyte predominance (CML.MP). BCR/ABL-positive essential thrombocythemia (Ph-positive ET) is featured by CML.MP bone marrow picture of small monolobulated megakaryocytes and is part of the CML spectrum as a malignant disease (neoplasia) with an obligate transition into acute leukemia of near to 100% after 10 years follow-up. The Hannover BM classification distinguished three primary prefibrotic BCR/ABL-negative (Ph-negative) myeloproiferative disorders (MPD)s: essential thrombocythemia (ET), polycythemia vera (PV) and chronic or primary megakaryocytic granulocytic myeloproliferation (CMGM/PMGM). The incidence of blasts crisis is low in the Phnegative MPDs ET, PV and CMGM. The risk of myelofibrosis is high in CMGM/PMGM, moderate in PV but low in Ph-negative ET. In BCR/ABL-positive thrombocythemia the platelets are small and indolent (non-reactive) and megakaryocytes are smaller than normal with hypolobulated nuclei caused by BCR/ABL induced maturation defect. BCR/ABL-positive thrombocythemia does not present erythromelalgic thrombotic or bleedings manifestations at increased platelet count in excess of 400 to 1500 × 10 9 /L. The platelets and megakaryocytes in BCR/ABL-negative ET and PV are large due to growth advantage caused by constitutively activated by the JAK2V617F or MPL515 mutation. JAK2 and MPL mutated thrombocythemias are associated with a high risk on aspirin responsive plateletmediated inflammation and thrombosis in the end-arterial circulation (platelet thrombophilia).

show abstract