Gelatinous Transformation of Bone Marrow in Chronic Myeloid Leukemia during Treatment with Imatinib Mesylate: A Disease or a Drug Effect?

Ram, Ron; Gafter‐Gvili, Anat; Okon, Elimelech; Pazgal, Idit; Shpilberg, Ofer; Raanani, Pia

doi:10.1159/000121825

Cited by 18 publications

(13 citation statements)

References 43 publications

(29 reference statements)

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“…Gelatinous marrow transformation is an unusual pathological manifestation reported recently in 2 cases of CML treated with Imatinib. It is unknown whether the effect of disease or drug [26].…”

Section: Discussionmentioning

confidence: 99%

Morphologic Changes in the Bone Marrow in Patients of Chronic Myeloid Leukemia (CML) Treated with ImatinibMesylate

Srinivas

Paul

Uppin

et al. 2012

Indian J Hematol Blood Transfus

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Imatinib mesylate (Gleevec) is an effective treatment for chronic myeloid leukemia (CML). Though cytogenetic and molecular analyses are essential disease monitoring parameters in CML bone marrow morphological response is not well defined. We examined marrow samples from 40 patients with CML which have at least 2 or more follow-up marrow. A significant positive correlation with complete cytogenetic response shown for normalization of cellularity (P = 0.0097), absence of dry tap (P = 0.0368) and abnormal megakaryocytes (P = 0.005), reduction of blasts (P = 0.019), basophils (P = 0.031), M:E index (P = 0.018) and fibrosis (P = 0.018). Morphological criteria for complete cytogenetic response in CML patients treated with Imatinib can be defined.Morphologic response is also of potential clinical value in addition to cytogenetic and molecular response in patients of CML treated with Imatinib.

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Section: Discussionmentioning

confidence: 99%

Morphologic Changes in the Bone Marrow in Patients of Chronic Myeloid Leukemia (CML) Treated with ImatinibMesylate

Srinivas

Paul

Uppin

et al. 2012

Indian J Hematol Blood Transfus

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“…Gelatinous transformation (serous atrophy) is a change where there is loss of fat cells and hematopoietic cells with replacement by acid mucopolysaccharide. It has been reported in severe malnutrition states, AIDS, renal failure and rarely in imatinib treated CML patients [11,12].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Cytopenias Occurring in Imatinib Treated Chronic Myeloid Leukemia (CML) Patients

Paul

Uppin

et al. 2010

Indian J Hematol Blood Transfus

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Imatinib Mesylate, a Tyrosine Kinase inhibitor, is presently the drug of choice for Chronic myeloid leukemia (CML). During therapy, a few patients develop myelosuppression and present with cytopenias. To study the bone marrow morphology in imatinib treated CML patients presenting with persistent cytopenias. The cases were retrieved from the Hematopathology record files, Department of Pathology; the study period being January 2008-June 2009. Cases of CML on Imatinib presenting with grade 2 or more anemia, neutropenia and/or thrombocytopenias with bone marrow studies, were included in the study. The morphology of all cases was reviewed with cytogenetic studies. Follow-up details were obtained from the Medical Oncology records. During the study period, 683 Imatinib treated CML patients had bone marrow studies as part of their follow-up investigations. Of these, 60 patients (9%) had some form of persistent cytopenia. The patients ranged from 21 to 75 years of age with a median age of 38 years. The male:female ratio was 1:1. There were 46 patients with ≥grade 2 anemia, 25 patients with ≥grade 2 neutropenia and 37 patients with ≥grade 2 thrombocytopenia. Of these, 18 patients had bicytopenia and 13 cases had pancytopenia. The marrow evaluation revealed morphologic response in 30 patients, persistent marrow disease in five patients, marrow hypoplasia in six patients, extensive stromal changes including fibrosis in five patients, megaloblastic erythropoiesis in 11 patients and disease progression to accelerated or blast crisis in three patients. Various degrees of cytopenias may occur in few patients of CML on imatinib therapy. Regular hematologic follow-up is required so that the drug may be stopped or dose modified as per the individual's needs.

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“…Gelatinous marrow transformation (GMT) is a rare manifestation of multiple malignant and non-malignant diseases [20]. Two cases of GMT in patients taking imatinib for CP CML have been reported.…”

Section: Gelatinous Marrow Transformation and Bone Marrow Necrosismentioning

confidence: 99%

Hematologic toxicities of small molecule tyrosine kinase inhibitors

2011

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Small molecule tyrosine kinase inhibitors (TKIs) are potent anti-cancer targeted therapies. TKIs are considered safe and efficacious therapeutic modalities, and are generally tolerated well. However, they are associated with certain side effects including hematologic toxicities such as anemia, macrocytosis, neutropenia, thrombocytopenia, hemolytic anemia, bone marrow aplasia and necrosis. Thrombotic microangiopathy, arterial thromboembolism and splenic infarction can also occur following treatment with TKIs. Cytopenias are the most common adverse effects associated with these agents, and other hematologic toxicities are not frequent. It is essential for clinicians to monitor patients closely, and recognize those side effects as early as possible, in order to improve efficacy of small molecule TKIs and optimize outcomes. This article summarizes hematologic toxicities associated with the commonly used small molecule TKIs. It also provides practical strategies for the management of these toxicities.

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Gelatinous Transformation of Bone Marrow in Chronic Myeloid Leukemia during Treatment with Imatinib Mesylate: A Disease or a Drug Effect?

Cited by 18 publications

References 43 publications

Morphologic Changes in the Bone Marrow in Patients of Chronic Myeloid Leukemia (CML) Treated with ImatinibMesylate

Morphologic Changes in the Bone Marrow in Patients of Chronic Myeloid Leukemia (CML) Treated with ImatinibMesylate

Evaluation of Cytopenias Occurring in Imatinib Treated Chronic Myeloid Leukemia (CML) Patients

Hematologic toxicities of small molecule tyrosine kinase inhibitors

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