Bone Marrow Findings in Patients With Acute Promyelocytic Leukemia Treated With Arsenic Trioxide

Karin P. Miller, Girish Venkataraman, Christopher Gocke, Denise Batista, Michael J Borowitz, Kathleen Burns, Keith Pratz, Amy S Duffield

Research output: Contribution to journalArticle

Abstract

Objectives: Increasingly, acute promyelocytic leukemia (APL) is treated with a combination of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). This study characterizes bone marrow findings after ATRA/ATO therapy. Methods: Bone marrow biopsies from 16 patients treated with ATRA/ATO and seven patients treated with ATRA/chemotherapy (CTX) for APL were evaluated. Results: In ATRA/ATO cases, the marrow was likely to be hypercellular (79%) with a decreased myeloid:erythroid (M:E) ratio (88%), megaloblastoid maturation of erythroid precursors (100%), erythroid atypia (75%), and increased (88%) and atypical (75%) megakaryocytes. Significant myeloid atypia was only seen in extensive residual disease. The ATRA/CTX cases were less likely to be hypercellular (38%), have a M:E ratio of 1:1 or less (0%), exhibit significant erythroid atypia (0%), or have increased (0%) or atypical (38%) megakaryocytes. Conclusions: Bone marrow biopsies from patients treated with ATO have unusual but characteristic features. Despite variability in marrow findings, clinical outcomes were uniformly favorable.

Original languageEnglish (US)
Pages (from-to)675-685
Number of pages11
JournalAmerican journal of clinical pathology
Volume152
Issue number5
DOIs
StatePublished - Oct 7 2019

Fingerprint

Acute Promyelocytic Leukemia
Tretinoin
Bone Marrow
Megakaryocytes
Biopsy
arsenic trioxide
Drug Therapy

Keywords

  • Acute promyelocytic leukemia
  • All-trans retinoic acid
  • Arsenic trioxide

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Bone Marrow Findings in Patients With Acute Promyelocytic Leukemia Treated With Arsenic Trioxide. / Miller, Karin P.; Venkataraman, Girish; Gocke, Christopher; Batista, Denise; Borowitz, Michael J; Burns, Kathleen; Pratz, Keith; Duffield, Amy S.

In: American journal of clinical pathology, Vol. 152, No. 5, 07.10.2019, p. 675-685.

Research output: Contribution to journalArticle

@article{f32a06d78cdc4944839f22d2015ccb0b,
title = "Bone Marrow Findings in Patients With Acute Promyelocytic Leukemia Treated With Arsenic Trioxide",
abstract = "Objectives: Increasingly, acute promyelocytic leukemia (APL) is treated with a combination of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). This study characterizes bone marrow findings after ATRA/ATO therapy. Methods: Bone marrow biopsies from 16 patients treated with ATRA/ATO and seven patients treated with ATRA/chemotherapy (CTX) for APL were evaluated. Results: In ATRA/ATO cases, the marrow was likely to be hypercellular (79{\%}) with a decreased myeloid:erythroid (M:E) ratio (88{\%}), megaloblastoid maturation of erythroid precursors (100{\%}), erythroid atypia (75{\%}), and increased (88{\%}) and atypical (75{\%}) megakaryocytes. Significant myeloid atypia was only seen in extensive residual disease. The ATRA/CTX cases were less likely to be hypercellular (38{\%}), have a M:E ratio of 1:1 or less (0{\%}), exhibit significant erythroid atypia (0{\%}), or have increased (0{\%}) or atypical (38{\%}) megakaryocytes. Conclusions: Bone marrow biopsies from patients treated with ATO have unusual but characteristic features. Despite variability in marrow findings, clinical outcomes were uniformly favorable.",
keywords = "Acute promyelocytic leukemia, All-trans retinoic acid, Arsenic trioxide",
author = "Miller, {Karin P.} and Girish Venkataraman and Christopher Gocke and Denise Batista and Borowitz, {Michael J} and Kathleen Burns and Keith Pratz and Duffield, {Amy S}",
year = "2019",
month = "10",
day = "7",
doi = "10.1093/ajcp/aqz087",
language = "English (US)",
volume = "152",
pages = "675--685",
journal = "American Journal of Clinical Pathology",
issn = "0002-9173",
publisher = "American Society of Clinical Pathologists",
number = "5",

}

TY - JOUR

T1 - Bone Marrow Findings in Patients With Acute Promyelocytic Leukemia Treated With Arsenic Trioxide

AU - Miller, Karin P.

AU - Venkataraman, Girish

AU - Gocke, Christopher

AU - Batista, Denise

AU - Borowitz, Michael J

AU - Burns, Kathleen

AU - Pratz, Keith

AU - Duffield, Amy S

PY - 2019/10/7

Y1 - 2019/10/7

N2 - Objectives: Increasingly, acute promyelocytic leukemia (APL) is treated with a combination of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). This study characterizes bone marrow findings after ATRA/ATO therapy. Methods: Bone marrow biopsies from 16 patients treated with ATRA/ATO and seven patients treated with ATRA/chemotherapy (CTX) for APL were evaluated. Results: In ATRA/ATO cases, the marrow was likely to be hypercellular (79%) with a decreased myeloid:erythroid (M:E) ratio (88%), megaloblastoid maturation of erythroid precursors (100%), erythroid atypia (75%), and increased (88%) and atypical (75%) megakaryocytes. Significant myeloid atypia was only seen in extensive residual disease. The ATRA/CTX cases were less likely to be hypercellular (38%), have a M:E ratio of 1:1 or less (0%), exhibit significant erythroid atypia (0%), or have increased (0%) or atypical (38%) megakaryocytes. Conclusions: Bone marrow biopsies from patients treated with ATO have unusual but characteristic features. Despite variability in marrow findings, clinical outcomes were uniformly favorable.

AB - Objectives: Increasingly, acute promyelocytic leukemia (APL) is treated with a combination of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). This study characterizes bone marrow findings after ATRA/ATO therapy. Methods: Bone marrow biopsies from 16 patients treated with ATRA/ATO and seven patients treated with ATRA/chemotherapy (CTX) for APL were evaluated. Results: In ATRA/ATO cases, the marrow was likely to be hypercellular (79%) with a decreased myeloid:erythroid (M:E) ratio (88%), megaloblastoid maturation of erythroid precursors (100%), erythroid atypia (75%), and increased (88%) and atypical (75%) megakaryocytes. Significant myeloid atypia was only seen in extensive residual disease. The ATRA/CTX cases were less likely to be hypercellular (38%), have a M:E ratio of 1:1 or less (0%), exhibit significant erythroid atypia (0%), or have increased (0%) or atypical (38%) megakaryocytes. Conclusions: Bone marrow biopsies from patients treated with ATO have unusual but characteristic features. Despite variability in marrow findings, clinical outcomes were uniformly favorable.

KW - Acute promyelocytic leukemia

KW - All-trans retinoic acid

KW - Arsenic trioxide

UR - http://www.scopus.com/inward/record.url?scp=85072994590&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85072994590&partnerID=8YFLogxK

U2 - 10.1093/ajcp/aqz087

DO - 10.1093/ajcp/aqz087

M3 - Article

C2 - 31305869

AN - SCOPUS:85072994590

VL - 152

SP - 675

EP - 685

JO - American Journal of Clinical Pathology

JF - American Journal of Clinical Pathology

SN - 0002-9173

IS - 5

ER -