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Therapy-Induced Marrow Changes

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Practical Lymph Node and Bone Marrow Pathology

Part of the book series: Practical Anatomic Pathology ((PAP))

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Abstract

Bone marrow biopsies performed on patients previously treated for hematological diseases and other malignancies often show therapy-induced changes. We have broadly grouped these pleiotropic effects into the following six categories:

  1. (a)

    Cytopenias or marked marrow hypocellularity from cytotoxic/cytolytic agents

  2. (b)

    Cytoses or marrow hypercellularity from growth factor therapies including granulocyte colony stimulating factor, erythropoietin, and thrombopoietin

  3. (c)

    Differentiation of malignant hematologic cells from agents such as all-trans retinoic acid (ATRA) or IDH 1/2 inhibitors

  4. (d)

    Dysplasia: therapy-associated dysmorphology

  5. (e)

    Secondary neoplasms: therapy-associated myeloid neoplasms and immunodeficiency-associated lymphoproliferative disorders.

  6. (f)

    Miscellaneous: Therapy-associated immunophenotypic shifts/drifts, clonal hematopoiesis, etc.

In this chapter, we focus on effects of various therapies on bone marrow elements that may be morphologically detected, which is the first five of the six categories. The role of the pathologist in these scenarios is to integrate the clinical history and pathological findings, to sift through the confounding factors and morphologic mimickers to arrive at the appropriate diagnosis. Considering the large number of medications used in hematologic disease, their broad pathologic effects, and wide differences in prognosis, this can be an extremely daunting task for specialists and generalists alike. This chapter seeks to categorize, characterize, and advise pathologists on the effects of therapy-related sequela on the hematologic system.

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Authors and Affiliations

  1. Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA

    Parul Bhargava & Jeffrey D. Whitman

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  1. Parul Bhargava
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Correspondence to Parul Bhargava .

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  1. Department of Pathology, Duke University School of Medicine and Duke Health System, Durham, NC, USA

    Endi Wang

  2. Department of Pathology, Duke University School of Medicine and Duke Health System, Durham, NC, USA

    Anand Shreeram Lagoo

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Bhargava, P., Whitman, J.D. (2020). Therapy-Induced Marrow Changes. In: Wang, E., Lagoo, A.S. (eds) Practical Lymph Node and Bone Marrow Pathology. Practical Anatomic Pathology. Springer, Cham. https://doi.org/10.1007/978-3-030-32189-5_32

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