Akut Myeloid Lösemi Hastalarında Kemik İliği Retikülin Fibrozisinin Sağkalım Üzerine Etkisi

The effect of bone marrow reticulin fibrosis on survival in acute myeloid leukemia patients

Although acute myeloid leukemia is a rare cancer, it is a disease that deserves attention because of its increasing incidence and high mortality. Many prognostic factors, in particular age and cytogenetic classification, are important in the management of AML. Identifying new prognostic factors will enhance our understanding of AML and contribute to improved survival.For the purpose of investigating the impact of bone marrow reticulin fibrosis on overall survival, a total of 121 patients with acute myeloid leukemia were included in the study. Out of these 121 patients, 70 (57.9%) were male and 51 (42.1%) were female. The mean age of all patients was 57.72±16.3 years.There was no bone marrow reticulin fibrosis in 56 patients (47.9%), first degree fibrosis in 47 patients (40.2%), second degree fibrosis in 13 patients (11.1%) and third degree fibrosis in 1 patient (0.9%). No correlation was found between bone marrow reticulin fibrosis and age, gender, FAB classification, or bone marrow blast rate at diagnosis. Patients in the unfavorable cytogenetic risk group had more bone marrow reticulin fibrosis. The mean overall survival was 17.4±1.9 months. In the group without bone marrow reticulin fibrosis, it was 18.87±2.77 months, while in the group with bone marrow reticulin fibrosis, it was 11.09±1.51 months. This observed difference was determined to be statistically significant. Therefore, the presence of bone marrow reticulin fibrosis was considered an important prognostic factor for overall survival.Scientific publications, which have increased significantly in recent years, have contributed to a better understanding of acute myeloid leukemia and thus to the development of new approaches. Pharmacological inhibition of bone marrow reticulin fibrosis could potentially offer clinical utility and extend patient survival. Further studies are needed to incorporate bone marrow reticulin fibrosis into prognostic risk classifications, to develop appropriate chemotherapy regimens, and to improve the clinical efficacy of treatment in AML patients.

Keywords:

Acute Myeloid Leukemia Bone Marrow Fibrosis, Prognostic Factors,

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1. Roberts TF. Acute myelogenous leukemia. In: Ferri FF, editor. Ferri's Clinical Advisor 2020: Elsevier; 2019. p. 58-63.
2. Key statistics for acute myeloid leukemia: The American Cancer Society; 2020 [08.01.2022]. Avaible from: https://www.cancer.org/cancer/acute-myeloid-leukemia/about/key-statistics.html.
3. Cancer facts & figures 2020: American Cancer Society; 2020 [10.01.2022]. Avaible from: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2020/cancer-facts-and-figures-2020.pdf.
4. SEER cancer stat facts: acute myeloid leukemia: National Cancer Institute; 2020 [22.02.2022]. Avaible from:. https://seer.cancer.gov/statfacts/html/amyl.html.
5. Wakui M, Kuriyama K, Miyazaki Y, Hata T, Taniwaki M, Ohtake S, et al. Diagnosis of acute myeloid leukemia according to the WHO classification in the Japan Adult Leukemia Study Group AML-97 protocol. International journal of hematology. 2008;87:144-51.
6. Seiter K, Harris J. Myeloid leukemia staging. N Engl J Acute Med. 1999;341(11):807-13.
7. Khoury JD, Solary E, Abla O, Akkari Y, Alaggio R, Apperley JF, et al. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Myeloid and Histiocytic/Dendritic Neoplasms. Leukemia. 2022;36(7):1703-19.
8. Appelbaum FR, Gundacker H, Head DR, Slovak ML, Willman CL, Godwin JE, et al. Age and acute myeloid leukemia. Blood. 2006;107(9):3481-5.
9. Walter RB, Othus M, Borthakur G, Ravandi F, Cortes JE, Pierce SA, et al. Prediction of early death after induction therapy for newly diagnosed acute myeloid leukemia with pretreatment risk scores: a novel paradigm for treatment assignment. Journal of clinical oncology. 2011;29(33):4417.
10. Buğdacı MS, Yanardağ H, Ar MC, Soysal T, Coşkun S, Demirci S. Pulmonary radiological findings in patients with acute myeloid leukemia and their relationship to chemotherapy and prognosis a single-center retrospective study. Turkish Journal of Hematology. 2012;29(3):217-22.
11. Kelkitli E, Atay H, Turgut M. Akut miyeloid lösemide prognostik faktörler. Turkiye Klinikleri J Hem Onc-Special Topics. 2010;3(2):31-4.
12. Terwijn M, Feller N, van Rhenen A, Kelder A, Westra G, Zweegman S, et al. Interleukin-2 receptor alpha-chain (CD25) expression on leukaemic blasts is predictive for outcome and level of residual disease in AML. European Journal of Cancer. 2009;45(9):1692-9.
13. Appelbaum FR, Walter RB. The acute leukemias. In: Goldman L, Schafer AI, editors. Goldman-Cecil Medicine. Volume 1. 26. ed: Elsevier; 2019. p. 1211-7.
14. Sanz MA, Lo Coco F, Martin G, Avvisati G, Rayon C, Barbui T, et al. Definition of relapse risk and role of nonanthracycline drugs for consolidation in patients with acute promyelocytic leukemia: a joint study of the PETHEMA and GIMEMA cooperative groups. Blood. 2000;96(4):1247-53.
15. Kuter DJ, Bain B, Mufti G, Bagg A, Hasserjian RP. Bone marrow fibrosis: pathophysiology and clinical significance of increased bone marrow stromal fibres. British journal of haematology. 2007;139(3):351-62.
16. Tefferi A. Myelofibrosis with myeloid metaplasia. New England Journal of Medicine. 2000;342(17):1255-65.
17. Scott BL, Storer BE, Greene JE, Hackman RC, Appelbaum FR, Deeg HJ. Marrow Fibrosis as a Risk Factor for Posttransplantation Outcome in Patients with Advanced Myelodysplastic Syndrome or Acute Myeloid Leukemia with Multilineage Dysplasia. Biology of Blood and Marrow Transplantation. 2007;13(3):345-54.
18. Zhang X, Wang F, Yu J, Jiang Z. Significance of bone marrow fibrosis in acute myeloid leukemia for survival in the real-world. Frontiers in Oncology. 2022;12:971082.
19. Wu Z, Chen R, Wu L, Zou L, Ding F, Wang M, et al. Bone marrow fibrosis at diagnosis predicts survival for primary acute myeloid leukemia. Clinical and Translational Oncology. 2017;19:1462-8.
20. Abou Dalle I, Nassif S, Bazarbachi A. Acute promyelocytic leukemia with increased bone marrow reticulin fibrosis: Description of three cases and review of the literature. Hematol Oncol Stem Cell Ther. 2018;11(2):99-104.
21. Reda G, Riva M, Fattizzo B, Cassin R, Giannarelli D, Pennisi M, et al. Bone Marrow Fibrosis and Early Hematological Response as Predictors of Poor Outcome in Azacitidine Treated High Risk-Patients With Myelodysplastic Syndromes or Acute Myeloid Leukemia. Semin Hematol. 2018;55(4):202-8.
22. Haznedaroglu I, Malkan U. Local bone marrow renin-angiotensin system in the genesis of leukemia and other malignancies. European Review for Medical & Pharmacological Sciences. 2016;20(19).
23. Islam A, Catovsky D, Goldman JM, Galton D. Bone marrow fibre content in acute myeloid leukaemia before and after treatment. Journal of clinical pathology. 1984;37(11):1259-63.
24. Tang T-C, Chang H, Sun C-F, Shih L-Y, Dunn P, Wang P-N, et al. Clinical Implications of Reticulin Fibrosis of Bone Marrow in De Novo Acute Myeloid Leukemia. American Society of Hematology; 2012.