therapy


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  • Residual disease

    • molecular (most sensitive)
      • IGH rearrangement
      • IGL rearrangment
      • TCR rearrangement
      • mutations the original had
    • flow (sensitive)
    • HLA based chimerism
    • morphology
    • stains
      • plasma cell neoplasm: CD138, kappa, lambda, CD56
      • Acute leukemia: CD34, TdT
      • any aberrant markers the original had
    • cytogenetics
      • karyotype
      • FISH

  • Regenerating hematopoiesis

    • etiologies: myeloablative therapy, stem cell transplant, drug damage
    • initial changes (1st week): marrow aplasia
      • lack hematopoietic cells, fat cells
      • background edema, fibrinoid necrosis
      • rare stromal cells, histiocytes, plasma cells, lymphocytes
    • intermediate changes (2nd week): regenerative islands (paratrabecular)
      • islands of left shifted erythroid and granulocytic cells
      • reappearance of fat cells
      • mild reticulin fibrosis
    • late changes (3rd week)
      • normalization of marrow cellularity
      • appearance of clusters of small megakaryocytes
      • resolution of reticulin fibrosis
    • stem cell transplant changes
      • interstitial regenerative islands
      • increased iron (storage and siderotic)
      • hemosiderin

  • Therapy related changes

    • therapy related neoplasms
      • alkylating agents, topo II inhibitors: MDS, MDS/MPN, AML
      • hydroxyurea for ET: MDS, AML with 17p del and p53
      • rarely can have ALL
    • G-CSF, GMCSF: toxic granulation, Dohle bodies, left shift leukocytosis
      • leukocytosis with left shift and transient blasts (blood and marrow)
      • toxic granulation, Dohle bodies
      • enlarged promyelocytes and myelocytes with prominent hoff, increased mitosis, binucleated promyelocytes later on
      • can also have NRBCs, LGLs, eosinophilia
    • erythropoietin: erythroid left shift, mild dyserythropoiesis
    • reactive increased erythroids in phlebotomy for PCV
    • thrombopoietin: megakaryocyte increase with atypical forms
    • anagrelide for ET: immature small megas
    • cytotoxic/ablative: necrosis (rule out aspiration artifact), fibrosis, serous atrophy (gelatinous atrophic marrow)

  • Signout

    • ***cellular bone marrow (***%) with ***hematopoiesis and ***% blasts by manual aspirate differential
    • Routine cytogenetic results reveal a ***donor/normal karyotype
    • FISH (***) results are ***normal
    • Flow cytometric analysis (MRD testing) results reveal *** aberrant population
    • for transplant:
      • DNA (post transplant-unfractionated assay) results reveal this sample contains greater than ***% cells of donor origin
      • DNA (fingerprinting fractionation assay, CD3+ enriched) results reveal CD3+ T cells in this sample contain greater than ***% cells of donor origin
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