Abdülkadir KARIŞMAZ, Ceyda ASLAN, Rafet EREN, Şermin ALTINDAL, Mehmet Hilmi DOĞU, Elif SUYANI

Philadelphia Kromozomu Negatif Myeloproliferatif Neoplazili Hastalarda Erirosit Dağılım Genişliği İndeksi ile Kemik İliği Fibrozisi Arasındaki İlişkinin Değerlendirilmesi

Giriş: Eritrosit dağılım genişliğinin (RDW) primer miyelofibroz hastalarında arttığı gösterilmiştir ve Philadelphia-negatif miyeloproliferatif neoplazilerde (MPN) kemik iliği fibrozisi varlığını tahmin etmede biyopsi yerine RDW’nin kullanılıp kullanılamayacağı ilgi çekicidir. Çalışmamızın amacı: Polisitemi vera (PV), esansiyel trombositoz (ET) ve PMF alt tiplerini içeren MPN’li hastalarda myelofibroz derecesi ile RDW değerleri arasındaki ilişkiyi değerlendirmektir. Yöntem: Hastanemizin Hematoloji Kliniği’nde 2010-2017 tarihleri arasında MPN tanısıyla takip edilen 118 hastanın verilerini retrospektif olarak inceledik Bulgular: Elli iki hastada PV, 60 hastada ET, 4 hastada PMF ve 2 hastada sınıflandırılamayan MPN saptandı. Derece 0 ve derece 1 retikülin fibrozisi bulunan 29 hasta (% 24,6) myelofibrozisi olmayan olarak, kalan 2 ≥ derece retikülin fibrozisi olan 89 (% 75,4) hasta ise myelofibrozisi bulunan olarak kabul edildi. Medyan RDW değeri %14,6 (%12,4-23,1) idi. Ortanca RDW değeri myelofibrozisi olmayan hastalarda %14.1 (%12.4-17.8) ve myelofibrozisli hastalarda %15 (12.4-23.1) olarak ortaya sonuçlandı (p = 0.054). Derece 3 fibrozisi olup ileri myelofibrozisi olan 8 hastanın alt grup analizinde medyan RDW değeri % 18.45 (16.4-23.1) ve kalan 110 hastada % 14.45 (%12.4-23) saptandı (p = 0.008). Sonuç: Bu çalışma, RDW ve myelofibroz arasındaki ilişki hakkında kesin bir sonuç sağlamasa da, artmış RDW’nin MPN’li hastalarda ileri kemik iliği fibrozisi varlığına işaret edebileceği görülmektedir.

The Association Between Red Cell Distribution Width and Bone Marrow Fibrosis in Patients with Philadelphia-Negative Myeloproliferative Neoplasms

Objective: Red cell distribution width (RDW) was shown to be increased in primary myelofibrosis (PMF) patients and it is intriguing whether RDW could be used instead of biopsy in predicting presence of bone marrow fibrosis (BMF) to some extend in Philadelphia-negative myeloproliferative neoplasms (MPNs) comprising polycytemia vera (PV), essential thrombocytosis (ET) and PMF. Our aim is to evaluate the relationship between BMF degree and RDW values in patients with MPNs. Method: We retrospectively reviewed the data of 118 patients, who were followed with the diagnosis of MPNs at our Hematology Clinic between 2010 and 2017. Results: 52 patients had PV, 60 had ET, 4 had PMF and 2 had unclassifiable MPN. Twentynine (24.6%) patients were with grade 0 and grade 1 reticulin fibrosis were considered to be free of BMF, and the remaining 89 (75.4%) patients with ≥ grade 2 reticulin fibrosis were considered to have BMF. The median RDW value was 14.6% (range 12,4-23,1%). The median RDW value revealed with 14.1% (range, 12.4-17.8) in patients without BMF and 15% (range, 12.4-23.1) in patients with BMF (p=0.054). In subgroup analysis of 8 patients with advanced BMF of grade 3, the median RDW value was 18.45% (range, 16.4-23.1) and it was 14.45% (range, 12.4-23) in the remaining 110 patients (p=0.008). Conclusion: Although the present study does not provide a precise conclusion about the association between RDW and BMF, it seems that increased RDW can point out the presence of advanced BMF in patients with MPNs.

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