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Is bone marrow examination indispensable in chronic myeloid leukemia at diagnosis?

Abstract Background Bone marrow aspiration and biopsy at presentation is important to demonstrate the phase of the disease, to provide material for cytogenetic studies and to demonstrate the myelofibrosis, which have prognostic and therapeutic implications. In the current era of molecular diagnostics, the role of bone marrow examination is questionable. The present study was designed to identify the role of bone marrow examination on phase migration, karyotyping and myelofibrosis. Methods Data of newly diagnosed CML patients seen between January 2013 and June 2018 was retrospectively analysed. CML was confirmed by demonstration of BCR-ABL fusion gene by PCR or FISH. Patients were stratified into chronic phase (CP), accelerated phase (AP) and blast phase (BP) according to WHO diagnostic criteria (2016). Results Of 749 patients, 541 patients had evaluable data. The male female ratio was 1.52:1 The median age at presentation was 37 years (range, 9-80 years). According to EUTOS risk stratification, 406 (75.1%) patients were low risk and 135(24.9%) were high risk. Based on bone marrow blasts criterion, phase migration occurred in 16 (2.9%). Of these 16 patients, phase migration from CP to AP, CP to BP and AP to BP were seen in 8 (50%), 4(25%) and 4 (25%) patients, respectively. Data on karyotyping was available in 195 (36%) patients. Of 195 patients, additional cytogenetic abnormalities were detected in 30 (15.3%) which includes, major route abnormalities in 11 (5.6%) patients. Of these 11 patients, 6 patients were in CP, 4 patients were in AP and 1 patient in BP. Myelofibrosis was demonstrated in 264 (48.7%) patients of which grade 1, grade 2, grade 3 and grade 4 were seen in 72 (13.3%), 100 (18.5%), 70 (12.9%); 20 (3.7%) patients respectively. Conclusions Bone marrow examination at presentation in CML patients results in phase migration, provides adequate material for cytogenetic studies and demonstrates presence of myelofibrosis. Hence, bone marrow examination is indispensable in newly diagnosed CML patients. Legal entity responsible for the study Nizam’s Institute of Medical Sciences. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.