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Acute Leukemias

Bone marrow fibrosis in childhood acute lymphoblastic leukemia correlates to biological factors, treatment response and outcome

Leukemia volume 22, pages 504–510 (2008)Cite this article

Abstract

We retrospectively evaluated reticulin fiber density (RFD) in 166 diagnostic bone marrow (BM) biopsies and 62 biopsies obtained at treatment day 29 from children with acute lymphoblastic leukemia (ALL). Patients with B-cell precursor (BCP)-ALL showed higher RFD as compared to patients with T-cell ALL (P<0.001). RFD correlated negatively with white blood cell count (P=0.008) in BCP-ALL patients. Patients with high-hyperdiploid ALL (51–61 chromosomes), no high-risk criteria and low RFD showed a favorable outcome when compared to similar patients with high RFD (P=0.002). In BCP-ALL patients, RFD at diagnosis correlated to the levels of minimal residual disease (MRD) analyzed by flow cytometry on treatment day 29 (P=0.001). Accordingly, patients with MRD⩾10−4 presented higher RFD at diagnosis compared to patients with MRD<10−4 (P=0.003). BCP-ALL patients with low RFD at diagnosis and a rapid reduction of RFD on day 29 had a favorable outcome compared to patients with the same baseline RFD level at diagnosis but a slow RFD reduction (P=0.041). To our knowledge, these findings are novel and may indicate BM fibrosis as a new valuable prognostic marker in childhood ALL. Expanded use of BM biopsy both at diagnosis and during follow-up is suggested.

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Acknowledgements

We thank Pernilla Andersson, Bigitta Ekholm and Elisabeth Dahlberg for technical assistance and Hans Stenlund for statistical advice. The Swedish Childhood Cancer Foundation and the Lions Cancer Research Foundation, Umeå University supported this work financially.

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Authors and Affiliations

  1. Department of Clinical Sciences, Pediatrics, Umea University, Umea, Sweden

    U Norén-Nyström & E Forestier

  2. Department of Medical Biosciences, Pathology, Umea University, Umeå, Sweden

    U Norén-Nyström, G Roos & A Bergh

  3. Department of Genetics and Pathology, Uppsala University, Uppsala, Sweden

    J Botling

  4. Department of Women's and Children's Health, University Children's Hospital, Uppsala, Sweden

    G Lönnerholm

  5. Department of Pathology, Karolinska University Hospital, Stockholm, Sweden

    A Porwit

  6. Childhood Cancer Research Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden

    M Heyman

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  1. U Norén-Nyström
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Correspondence to U Norén-Nyström.

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Supplementary Information accompanies the paper on the Leukemia website (http://www.nature.com/leu)

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Norén-Nyström, U., Roos, G., Bergh, A. et al. Bone marrow fibrosis in childhood acute lymphoblastic leukemia correlates to biological factors, treatment response and outcome. Leukemia 22, 504–510 (2008). https://doi.org/10.1038/sj.leu.2405072

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