The evaluation of the relationship between variation of bone marrow biopsy reticulin fiber degree and prognostic factors in acute and chronic leukemias

INTRODUCTION: Abnormal rise in collagen amount of bone marrow is called myelofibrosis; the grade of reticulin fiber is used to evaluate its rate. Many studies were performed to evaluate the relationship between acute/chronic leukemia and reticulin fiber grade with conflicting results. We could not find any study that compares prognostic factors and reticulin fiber grade in acute and chronic leukemias together. Our aim is to evaluate whether significant reticulin fiber change occurs with therapy in acute and chronic leukemia patients. In addition to that, we planned to evaluate the relationship between prognosis and reticulin fiber grade during diagnosis and its significance.METHOD: We enlist age, gender, leucocyte count, cytogenetics, extramedullary involvement, additional disease and malignancy, number of therapies, total life duration, remission statue, disease free survival and reticulin fiber of patients who were hospitalized between 2004 to 2010 with a diagnosis of AML, ALL, CML, CLL and HCL in our service. We also enlist FAB type, Auer rod and CD34 expression in AML, FAB type, time to remission and Philedelphia chromosome in ALL, Socal Score and stage in CML, stage and LDH level in CLL and spleen size in HCL. We evaluate the relationship between prognostic factors and reticulin fiber grade.RESULTS: Eightythree patients were included in our study and we could not find significant change of reticulin fiber grade with therapy. We found weak positive correlation between total life duration and first reticulin fiber grade and moderate negative correlation between number of therapies and second reticulin fiber grade. Moderate negative correlation was also found between disease free survival and number of therapies. Total life duration of patients with HCL and CML were mean 53,25 and 39,83 months and median 51,5 and 36 months respectively. Total life duration of patients with HCL and CML were significantly longer compared to AML and ALL groups.DISCUSSION AND CONCLUSION: Disease free survival and total life duration are significantly longer in CML and HCL patients? compared to AML and ALL. Patients diagnosed as CML and HCL have increased reticulin fiber content and mean number of therapy they received is less than the other groups. 41,6 % of CML patients and 50 % of HCL patients have more than grade 2 reticulin fiber. 83,3 % of CML patients and 100 % of HCL patients are in remission after one therapy. Also, in literature, it was shown that, reticulin fiber grade were shown to be decreased by chemotherapy irrespective of remission status. We think that, our results can be related to those findings. From data in our study, we think that larger and prospective case studies must be done in this field.