Abstract:
Introduction: In hematolymphoid malignancies a proper evaluation of bone marrow smears is important to assess post-chemotherapy related changes in bone marrow. Morphological examination holds importance in differentiating between marrow in remission vs minimal residual disease. In acute leukemias is necessary to identify relapses, and clues that predict the response during treatment and follow up to improve the sustained remission rate. Despite the current use of flow cytometry and quantitative PCR test for MRD assessment, there are very few studies highlighting the importance of cytomorphological assessment of bone marrows received post induction chemotherapy. Hence this short case series aims at highlighting importance of morphological examination of bone marrow in cases post induction chemotherapy.
Material and Methods: A Retrospective, descriptive study was done on 20 cases of post induction bone marrow samples of Acute leukemias.The bone marrow aspirate smears were analysed for morphological changes. Slides were stained with Leishman stain,H&E staining and special stains with PAS,MPO and Perls stain was done where required. This was a descriptive analysis.
Results: All the cases showed variability in morphology and post chemotherapy changes.75%(15/20 cases) show megaloblastoid features in intermediate normoblasts.40% cases show (8 /20) dyserythropoiesis. Dysmegakaryopoiesis was seen in 55%(11/20 cases) showed dysmegakryopoiesis, while 50%(10/20 cases) showed reduced cellularity.1 case showed relpase.90%(18/20)cases showed presence of hematogones/blast like cells. 3 out of those 18 cases where hematogones /blast like cells were MRD positive even when there was no clinical suspicion for relapse. Dysmyelopoiesis was noted in 65%(13/20)cases. 75%(15/20)cases showed presence of hemosiderin laden macrophages/hemophagocytosis. Erythroid predominance was seen in 85%(17/20) cases.
Conclusion: Morphological assessment of post induction bone marrows is extremely important as it is an important cytomorphological clue to assess whether the treatment is effective or not as well as to alert the clinician for any finding which is unsuspected by the clinician.
Audience Take Away Notes:
Authors want to highlight the importance of morphological examination of bone marrows post induction chemotherapy, which may hold important clues which can guide clinicians regarding treatment response and outcomes as well as alert clinicians for impending relapse etc which have not been suspected clinically.
