Myelofibrosis in Patients of Chronic Myeloid Leukemia in Chronic Phase at Presentation

Abstract

Objective: To determine the frequency and grading of myelofibrosis in patients of chronic myeloid leukaemia in chronic phase, and the association of cytopenias/cytosis with the degree of fibrosis. Study Design: Descriptive study. Place and Duration of Study: King Edward Medical University, Lahore, from March 2015 to April 2017. Methodology: Patients of both genders and all age groups with Philadelphia chromosome/BCR-ABL positivity were included in the study. Detailed medical history and examination findings were recorded. Sample for CBC was taken in EDTA and run on automated haematology analyser. Bone marrow aspirate and trephine biopsy was done from posterior iliac crest. Bone marrow aspirate slides were stained with Giemsa stain. The trephine biopsy was processed and stained with haematoxilyn and eosin. Silver (reticulin) and trichrome staining was done on trephine biopsy to assess the degree of fibrosis. Grading of fibrosis was done according to WHO revised classification 2016. Results: Among the 82 cases, 65% (n=53) were having WHO Grade MF 1 myelofibrosis, 27% (n=22) WHO Grade MF 2 myelofibrosis; whereas, 08% (n=07) WHO Grade MF 3 myelofibrosis. CBC counts were analysed to see any association between anemia, thrombocytocytosis and leucocytosis with advanced fibrosis (p=0.148, 0.413 and 0.174, respectively). Conclusion: Some degree of bone marrow fibrosis was present in all patients of chronic myeloid leukemia, while advance fibrosis (WHO Grade MF 2 and 3) is also common. Peripheral blood counts are not predictor of increased fibrosis. Therefore, bone marrow biopsy with special staining should be done in all cases of chronic phase of CML.