COMPARISION OF POST CHEMOTHERAPY BONE MARROW CHANGES IN ALL AND AML

Pankaj Bahadur Nepali* and Bhawani Manandhar

ABSTRACT

Introduction: The incidence of Acute leukaemia both AML and ALL has been increasing over the years. Chemotherapeutic agents used in the treatment of acute leukemia cause damage to the hematopoietic environment of the bone marrow initially, followed by stages of hematopoietic recovery. The study of post chemotherapy bone marrow in ALL and AML is essential to analyse the response to chemotherapy and also to study the effects of chemotherapeutic drugs on the bone marrow micro environment and to compare and evaluate bone marrow changes in ALL and AML. Aims: 1) To study the changes in the marrow due to chemotherapeutic agents in AML patients. 2) To study the response of leukemia to these drugs. 3) To study and compare bone marrow findings in the post induction phase and maintenance phase. Materials and methods: Total 65 cases of acute leukemia (50 cases of ALL and 15 cases of AML) in the post induction phase were enrolled for the study, out of these 44 cases (31 from ALL and 13 from AML) were followed up in the maintenance phase. Bone marrow aspirate and biopsy slides were studied for these cases. Results: In the post induction phase bone marrow aspirates were predominantly hypocellular in ALL (46%) whereas bone marrow aspirates were predominantly hypocellular and dry tap in AML (66.6%) with normal to increased erythroid regeneration (ALL-74%,AML-33.3%) but decreased myelopoiesis and megakaryopoiesis. The erythroid maturation was mainly in the form of normoblastic(ALL-84%, AML-40%) or normoblastic with megaloblastoid changes (ALL-40%, AML-6.7%). Dyspoiesis was present in all three lineages of ALL and AML (Erythroid series -46% and 20%, Myeloid series - 28% and 20%, Megakaryocytes- 28% and 20%). In the maintenance phase bone marrow was normocellular or hypercellular (ALL-67.8%, AML-69.3%) with normal to increased erythropoiesis (ALL-80.7, AML-53.0%) and predominantly normoblastic maturation (ALL-83.9%, AML-76.9%). Regeneration of myeloid series (ALL-61.3%, AML-69.3%) and megakaryocytes (ALL-96.7%, AML-76.9%) was also improved than in post induction phase. In the maintenance phase erythroid and myeloid dyspoiesis were decreased in ALL but increased in AML whereas megakaryocytic dyspoiesis was increased in post induction phase and persisted in maintenance phase of both ALL and AML cases. Conclusion: Hence the study shows both in ALL and AML though the bone marrow is hypocellular in the post induction phase, the cellularity improves during the maintenance phase. In the post induction phase erythroid regeneration appear first followed by myeloid and megakaryocytic regeneration. In our study dry tap, relapse, and death were more in AML in compare to ALL. It indicates ALL has better prognosis than AML.

Keywords: Post chemotherapy, Bone marrow, ALL, AML.