|A Bone Marrow Biopsy (BMB), though not essential for diagnosing Chronic Myeloid Leukemia (CML) in chronic phase, remains a firstline investigation in the work-up, prognostication and follow-up of this disorder. It demonstrates histological and topographic features, proliferation patterns, detects CML metamorphosis and fibrosis and is indispensable in the investigation of unexplained cytopenias during therapy.
Imatinib mesylate therapy significantly decreases cellularity, neutrophil granulopoiesis, abnormal micromegakaryocytes, microvessel density and cell proliferation indices with regression of myelofibrosis. There is an increase in erythroid precursors and reactive lymphoid nodules with enhanced apoptosis. Myeloblasts, CD34+ cells and immature myelomonocytic cells also decrease in patients who go into complete or partial remission. Imatinib-associated marrow aplasia has been described. Interferon-alpha induces apoptosis, resulting in reduced cellularity, expansion of normal erythropoiesis with increased iron-laden histiocytes and reticulum cells. Busalfan promotes myelofibrosis while hydroxyurea prevents it in a significant number of patients.
Kapil Verma, Bone Marrow Research in USA
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