Chronic granulocytic leukaemia: clinical course, blood and bone marrow changes after chemotherapy and splenectomy
Spiers, A.S.; Ermidou-Sazeidis, C.; Richards, H.G.
Haematologica 64(5): 616-634
1979
ISSN/ISBN: 0390-6078 PMID: 116922 Document Number: 139872
Fourteen patients with chronic granulocytic leukemia (CGL) were followed from diagnosis; 7 have died. During the chronic phase of CGL, 13 patients underwent elective splenectomy; there was no serious morbidity and the course of post-operative thrombocytosis was benign. Ten patients were treated with 7 antileukemic drugs used singly in a predetermined cyclical rotation and 3 patients received dehydroxyurea and mercaptopurine in alternating 3-mo. cycles. Both treatments effectively controlled the disease with remarkably few side effects. Differential cell counts of the bone marrow and histological sections of marrow particles were followed serially from diagnosis and during therapy. The abnormal marrow histology in untreated CGL was characteristic, with reduced fat spaces and massive hypercellularity not seen in normal marrow, acute inflammation or polycythemia vera. During treatment there was usually a qualitative alteration of the marrow differential counts toward normal but the abnormality of marrow particle histology usually persisted despite clinical improvement and near normal peripheral blood counts. Two patients developed osteolytic myeloblastomas and a 3rd died after metamorphosis of his CGL to a picture resembling erythremic myelosis. Serial pathological study of the bone marrow in CGL during treatment underlined the inadequacy of present drug therapy in attempted control of this disease.