TY - JOUR
T1 - Bone marrow necrosis in acute leukemia
T2 - Clinical characteristic and outcome
AU - Badar, Talha
AU - Shetty, Aditya
AU - Bueso-Ramos, Carlos
AU - Cortes, Jorge
AU - Konopleva, Marina
AU - Borthakur, Gautam
AU - Pierce, Sherry
AU - Huang, Xuelin
AU - Chen, Hsiang Chun
AU - Kadia, Tapan
AU - Daver, Naval
AU - Dinardo, Courtney
AU - O'Brien, Susan
AU - Garcia-Manero, Guillermo
AU - Kantarjian, Hagop
AU - Ravandi, Farhad
N1 - Publisher Copyright:
© 2015 Wiley Periodicals, Inc.
PY - 2015/9/1
Y1 - 2015/9/1
N2 - Bone marrow necrosis (BMN) is characterized by infarction of the medullary stroma, leading to marrow necrosis with preserved cortical bone. In reported small series, BMN in hematological malignancies is associated with poor prognosis. We sought to find the impact of BMN on clinical outcome in a relatively larger cohort of patients with acute leukemias. Overall we evaluated 1,691 patients; 1,051 with acute myeloid leukemia (AML) and 640 with acute lymphocytic leukemia referred to our institution between 2002 and 2013. Patients with AML and acute lymphoblastic leukemia (ALL) were evaluated separately to determine the incidence of BMN, associated clinical features and its prognostic significance. At initial diagnosis, BMN was observed in 25 (2.4%) patients with AML and 20 (3.2%) patients with ALL. In AML, BMN was significantly associated with French-American-British AML M5 morphology (32% vs. 10%, P=0.002). The complete remission (CR) rate in AML with and without BMN was 32% and 59% respectively (P=0.008). Likewise, CR rate in ALL with BMN was also inferior, 70% vs. 92% (P=0.005). The median overall survival (OS) in AML with BMN was significantly poorer, 3.7 months compared to 14 months without BMN (P=0.003). Similarly, the median OS in ALL with and without BMN was 61.7 and 72 months respectively (P=0.33). BMN is not a rare entity in AML and ALL, but is infrequent. BMN in AML and in ALL is suggestive of inferior response and poor prognosis.
AB - Bone marrow necrosis (BMN) is characterized by infarction of the medullary stroma, leading to marrow necrosis with preserved cortical bone. In reported small series, BMN in hematological malignancies is associated with poor prognosis. We sought to find the impact of BMN on clinical outcome in a relatively larger cohort of patients with acute leukemias. Overall we evaluated 1,691 patients; 1,051 with acute myeloid leukemia (AML) and 640 with acute lymphocytic leukemia referred to our institution between 2002 and 2013. Patients with AML and acute lymphoblastic leukemia (ALL) were evaluated separately to determine the incidence of BMN, associated clinical features and its prognostic significance. At initial diagnosis, BMN was observed in 25 (2.4%) patients with AML and 20 (3.2%) patients with ALL. In AML, BMN was significantly associated with French-American-British AML M5 morphology (32% vs. 10%, P=0.002). The complete remission (CR) rate in AML with and without BMN was 32% and 59% respectively (P=0.008). Likewise, CR rate in ALL with BMN was also inferior, 70% vs. 92% (P=0.005). The median overall survival (OS) in AML with BMN was significantly poorer, 3.7 months compared to 14 months without BMN (P=0.003). Similarly, the median OS in ALL with and without BMN was 61.7 and 72 months respectively (P=0.33). BMN is not a rare entity in AML and ALL, but is infrequent. BMN in AML and in ALL is suggestive of inferior response and poor prognosis.
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U2 - 10.1002/ajh.24074
DO - 10.1002/ajh.24074
M3 - Article
C2 - 26017166
AN - SCOPUS:84939567272
SN - 0361-8609
VL - 90
SP - 769
EP - 773
JO - American Journal of Hematology
JF - American Journal of Hematology
IS - 9
ER -