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Zhang X, Wang F, Yu J, Jiang Z. Significance of bone marrow fibrosis in acute myeloid leukemia for survival in the real-world. Front Oncol 2022; 12:971082. [PMID: 36276150 PMCID: PMC9585239 DOI: 10.3389/fonc.2022.971082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/22/2022] [Indexed: 11/25/2022] Open
Abstract
Acute myeloid leukemia (AML) is a highly heterogeneous hematologic malignancy characterized by the proliferation of myeloid blasts. Bone marrow fibrosis (BMF), characterized by increased deposition of reticulin or collagen fibers, can occur in AML. International authoritative guidelines do not mention AML patients with BMF and the reported studies are inconsistent. Therefore, we retrospectively analyzed the clinical data of newly diagnosed AML patients in our hospital and compared the clinical characteristics, gene mutations and prognosis of AML patients with or without BMF. We found AML patients with BMF tended to be older, were more prone to hepatosplenomegaly, their level of β2-MG was higher and they often had karyotypes associated with a poor prognosis. The proportion of AML patients without BMF was high in the intermediate-risk group and low in the high-risk group. The mutation rates of ASXL1 and TET2 genes were higher and that of CEBPA was lower in the BMF group. Multivariate analysis showed BMF had independent prognostic significance. AML patients without BMF had higher CR/CRi rate, and the time of hematopoietic recovery in patients achieving CR/CRi was longer in BMF group. The degree of BMF, prognostic level and blasts in peripheral blood were independent risk factors for CR/CRi in newly diagnosed AML. AML patients in the BMF group, especially those with BMF ≥ 2, had a lower OS rate. In age<60 years old group, the higher the degree of BMF was, the shorter the median survival time and the lower the OS rate. In age ≥ 60 years old group, the median survival time in the BMF-1 and the BMF-2/3 groups was shorter. For AML with low, intermediate and high risk, there was always a lower OS rate in patients with BMF. The median survival of AML patients decreased with an increasing degree of BMF in different risk stratifications. BMF had no effect on OS of AML patients with HSCT. In conclusion, AML patients with BMF have a poor prognosis, and BMF was an independent prognostic factor for OS. The assessment of BMF was of great significance for the treatment efficacy and prognosis of newly diagnosed AML.
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Affiliation(s)
- Xia Zhang
- *Correspondence: Xia Zhang, ; Zhongxing Jiang,
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2
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McLaughlin N, Ruan G, Day CN, Harmsen WS, Smith CJ, Binder M, Gangat N, Go RS, Tefferi A, Shah MV. A population-based study of acute panmyelosis with myelofibrosis in the United States: 2004-2015. Am J Hematol 2022; 97:E144-E147. [PMID: 35025125 DOI: 10.1002/ajh.26467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/07/2022]
Affiliation(s)
| | - Gordon Ruan
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Courtney N. Day
- Division of Biomedical Statistics and Informatics Mayo Clinic Rochester Minnesota USA
| | - William S. Harmsen
- Division of Biomedical Statistics and Informatics Mayo Clinic Rochester Minnesota USA
| | - Caleb J. Smith
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Moritz Binder
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Naseema Gangat
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Ronald S. Go
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Ayalew Tefferi
- Division of Hematology Mayo Clinic Rochester Minnesota USA
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Kong LZ, Li J, Wang RC, Kang L, Wei Q, Li Y. Simultaneous Follicular Lymphoma and Myelofibrosis: Report of a Case with Review of the Literature. Onco Targets Ther 2021; 14:4551-4559. [PMID: 34466001 PMCID: PMC8403076 DOI: 10.2147/ott.s313428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background Myelofibrosis (MF) is often associated with chronic myeloid leukemia, myelodysplastic syndrome and primary myeloproliferative neoplasms (MPN), but few number cases of malignant lymphoma with myelofibrosis was reported, and a few cases about follicular lymphoma with MF were found. Here we described a case of follicular lymphoma (FL) complicated by myelofibrosis. Case Presentation A 43-year-old man was diagnosed with follicular lymphoma (FL) complicated by MF, besides, the lymphoma staging of this patient was AnnArbor IV B. The cytokines of plated-derived growth factor (PDGF), basic fibroblast growth factor (b-FGF), vascular endothelial growth factor (VEGF), tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β), interleukin-2 (IL-2), and transforming growth factor-β (TGF-β) were positive, while JAK2V617F, MPL, and CALR mutations were negative. After first course of chemotherapy, the peripheral blood and MF improved. The systemic superficial lymph nodes and spleen were significantly narrowed after the third cycle of chemotherapy. Conclusion The production of various cytokines, such as b-FGF, TNF-α, TGF-β, PDGF, IL-1β, IL-2, IL-6, IL-10, may contribute to the development of MF.
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Affiliation(s)
- Ling-Zhijie Kong
- Department of Haematology, Hebei General Hospital, Shijiazhuang, Hebei, People's Republic of China.,Hebei North University, Zhangjiakou, Hebei, People's Republic of China
| | - Jing Li
- Department of Hematology, Hebei Province Hospital of Chinese Medicine, Shijiazhuang, Hebei, People's Republic of China
| | - Rui-Cang Wang
- Department of Haematology, Hebei General Hospital, Shijiazhuang, Hebei, People's Republic of China
| | - Lin Kang
- Department of Pathology, Hebei General Hospital, Shijiazhuang, Hebei, People's Republic of China
| | - Qiang Wei
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, Hebei, People's Republic of China
| | - Yan Li
- Department of Haematology, Hebei General Hospital, Shijiazhuang, Hebei, People's Republic of China
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4
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Salama ME. Important Pathologic Considerations for Establishing the Diagnosis of Myelofibrosis. Hematol Oncol Clin North Am 2021; 35:267-278. [PMID: 33641868 DOI: 10.1016/j.hoc.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diagnostic criteria for primary myelofibrosis as defined by the 2017 revised World Health Organization (WHO) classification system incorporate clinical and laboratory findings, including driver mutational status (JAK2, MPL, CALR. and triple negative). The WHO emphasized the role of histopathology in making an accurate diagnosis of primary myelofibrosis and successfully incorporated a fibrosis scoring system and scoring schemas for collagen fibrosis and osteosclerosis. These steps represent a significant addition to the standardization of myelofibrosis evaluation and minimize the risk for misdiagnosis. This article reviews important pathologic considerations along with highlights of potentially relevant pitfalls relevant to histopathological diagnosis of myelofibrosis.
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Affiliation(s)
- Mohamed E Salama
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic School of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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5
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Aksu T, Kuşkonmaz B, Unal S, Saglam A, Gümrük F. Acute promyelocytic leukemia in a child with reticulin fibrosis. J Hematop 2020. [DOI: 10.1007/s12308-020-00409-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Garmezy B, Schaefer JK, Mercer J, Talpaz M. A provider's guide to primary myelofibrosis: pathophysiology, diagnosis, and management. Blood Rev 2020; 45:100691. [PMID: 32354563 DOI: 10.1016/j.blre.2020.100691] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 03/20/2020] [Accepted: 04/02/2020] [Indexed: 12/23/2022]
Abstract
Although understanding of the pathogenesis and molecular biology of primary myelofibrosis continues to improve, treatment options are limited, and several biological features remain unexplained. With an appropriate clinical history, exam, laboratory evaluation, and bone marrow biopsy, the diagnosis can often be established. Recent studies have better characterized prognostic factors and driver mutations in myelofibrosis, facilitated by use of next-generation sequencing. These advances have facilitated development of a management strategy that is based on both risk factors and clinical phenotype. For low-risk patients, treatment will depend on symptom severity. For patients with higher-risk disease, several treatments are available including JAK inhibitors, allogeneic hematopoietic stem cell transplant, and clinical trials using novel molecularly targeted therapies and rational drug combinations. In this review, we outline what is known about the disease pathogenesis, discuss an approach to reaching the diagnosis, review the prognosis of myelofibrosis, and detail current therapeutic strategies.
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Affiliation(s)
- Benjamin Garmezy
- Division of Cancer Medicine, UT MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Jordan K Schaefer
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Jessica Mercer
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Moshe Talpaz
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI 48109, USA.
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7
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Pantic M, Pfeifer D, Kapp-Schwoerer S, Ihorst G, Becker H, Zeiser R, Duyster J, Schmitt-Graeff A. TP53 abnormalities and chromosomal aneuploidy in acute panmyelosis with myelofibrosis. Leukemia 2019; 33:2956-2962. [DOI: 10.1038/s41375-019-0523-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/16/2019] [Accepted: 05/09/2019] [Indexed: 12/17/2022]
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8
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Acute myeloid leukemia with translocation (1;21). Mol Biol Rep 2018; 45:347-351. [PMID: 29569103 DOI: 10.1007/s11033-018-4168-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
Abstract
Advancement in genetic and molecular biology techniques has greatly helped our understanding of various diseases, especially hematological disorders. We describe a case of primary myelofibrosis (PMF) that transformed into acute myeloid leukemia with a very rare and unusual genetic translocation of (1;21). There are only five reported cases of this translocation in acute myeloid leukemia (AML) or myelodysplastic syndrome but none of them transformed from PMF. This case not only highlights the importance of rare genetic translocations but also provides the natural history of the disease and its poor prognosis. To the best of our knowledge our patient is the first reported case of AML transformed from PMF to have this unique translocation of (1;21).
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Ramos F, Robledo C, Izquierdo-García FM, Suárez-Vilela D, Benito R, Fuertes M, Insunza A, Barragán E, Del Rey M, García-Ruiz de Morales JM, Tormo M, Salido E, Zamora L, Pedro C, Sánchez-Del-Real J, Díez-Campelo M, Del Cañizo C, Sanz GF, Hernández-Rivas JM. Bone marrow fibrosis in myelodysplastic syndromes: a prospective evaluation including mutational analysis. Oncotarget 2017; 7:30492-503. [PMID: 27127180 PMCID: PMC5058695 DOI: 10.18632/oncotarget.9026] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/17/2016] [Indexed: 02/07/2023] Open
Abstract
The biological and molecular events that underlie bone marrow fibrosis in patients with myelodysplastic syndromes are poorly understood, and its prognostic role in the era of the Revised International Prognostic Scoring System (IPSS-R) is not yet fully determined. We have evaluated the clinical and biological events that underlie bone marrow fibrotic changes, as well as its prognostic role, in a well-characterized prospective patient cohort (n=77) of primary MDS patients. The degree of marrow fibrosis was linked to parameters of erythropoietic failure, marrow cellularity, p53 protein accumulation, WT1 gene expression, and serum levels of CXCL9 and CXCL10, but not to other covariates including the IPSS-R score. The presence of bone marrow fibrosis grade 2 or higher was associated with the presence of mutations in cohesin complex genes (31.5% vs. 5.4%, p=0.006). By contrast, mutations in CALR, JAK2, PDGFRA, PDGFRB,and TP53 were very rare. Survival analysis showed that marrow fibrosis grade 2 or higher was a relevant significant predictor for of overall survival, and independent of age, performance status, and IPSS-R score in multivariate analysis.
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Affiliation(s)
- Fernando Ramos
- Department of Hematology, Hospital Universitario de León, León, Spain.,Instituto de Biomedicina (IBIOMED), Universidad de León, León, Spain
| | - Cristina Robledo
- Unidad de Diagnóstico Molecular y Celular del Cáncer, IBSAL, IBMCC-Centro de Investigación del Cáncer (USAL-CSIC), Salamanca, Spain
| | | | | | - Rocío Benito
- Unidad de Diagnóstico Molecular y Celular del Cáncer, IBSAL, IBMCC-Centro de Investigación del Cáncer (USAL-CSIC), Salamanca, Spain
| | - Marta Fuertes
- Department of Hematology, Hospital Universitario de León, León, Spain
| | - Andrés Insunza
- Department of Hematology, Hospital Universitario U. Marqués de Valdecilla, Santander, Spain
| | - Eva Barragán
- Department of Molecular Pathology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Mónica Del Rey
- Unidad de Diagnóstico Molecular y Celular del Cáncer, IBSAL, IBMCC-Centro de Investigación del Cáncer (USAL-CSIC), Salamanca, Spain
| | | | - Mar Tormo
- Department of Hematology-Oncology, Hospital Clínico Universitario, Valencia, Spain
| | - Eduardo Salido
- Department of Hematology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Lurdes Zamora
- Unit of Molecular Genetics, ICO-Hospital Germans Trias i Pujol, Institut de Recerca contra la Leucèmia Josep Carreras, Badalona, Spain
| | - Carmen Pedro
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | | | | | | | - Guillermo F Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Jesús María Hernández-Rivas
- Unidad de Diagnóstico Molecular y Celular del Cáncer, IBSAL, IBMCC-Centro de Investigación del Cáncer (USAL-CSIC), Salamanca, Spain.,Department of Hematology, Hospital Universitario de Salamanca, Spain
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Abstract
Primary myelofibrosis (PMF) is a myeloproliferative neoplasm classified according to the 2016 revision of World Health Organization Classification of Tumors and Haematopoietic and Lymphoid Tissue. Ruxolitinib is an oral inhibitor of Janus kinase approved in the USA for the treatment of intermediate or high-risk PMF and approved in Europe for the treatment of splenomegaly and constitutional symptoms of the disease. More recently, case reports described serious opportunistic infections in this neoplasm treated with ruxolitinib. Research studies demonstrated the immunological derangement of this compound mainly based on T, dendritic, and natural killer cell defects. The purpose of this review of the literature was to analyze the relationship among ruxolitinib, immune system and bacterial, viral, fungal, and protozoan infections. A literature search was conducted using PubMed articles published between January 2010 and November 2016. The efficacy of drug in patients with PMF was demonstrated in two phase III studies, Controlled MyeloFibrosis Study with ORal Jak inhibitor Treatment (COMFORT-I and COMFORT-II). Grade 3 and 4 neutropenia were recognized in 7.1% and 2% of patients in the ruxolitinib and placebo arm of COMFORT-I. Grade 3 or 4 neutropenia or leukopenia were observed in 8.9% and 6.3% of ruxolitinib treated patients of 5-year follow-up of COMFORT-II. In addition, leukocyte subpopulations, lymphocyte functions, or antibody deficiency were not documented in either of the studies. The complex interactions between ruxolitinib, bone marrow, immune system, and infections in PMF need further investigation, robust data from a randomized clinical trial, registry, or large case-series.
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Affiliation(s)
- Palma Manduzio
- Department of Haematology and Oncology, Haematology With BMT, IRCCS, Casa Sollievo della Sofferenza, Foggia, Italy
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11
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Stelling A, Jonas BA, Rashidi HH, Abedi M, Chen M. Acute Myeloid Leukemia with Isolated Trisomy 19 Associated with Diffuse Myelofibrosis and Osteosclerosis. Cancers (Basel) 2015; 7:2459-65. [PMID: 26694466 PMCID: PMC4695903 DOI: 10.3390/cancers7040903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/09/2015] [Accepted: 12/07/2015] [Indexed: 11/16/2022] Open
Abstract
Primary myelofibrosis (PMF), per WHO criteria, is a clonal myeloproliferative neoplasm that usually presents with a proliferation of granulocytic and megakaryocytic lineages with an associated fibrous deposition and extramedullary hematopoiesis. The bone marrow histologic findings of this disorder are typically characterized by the presence of myeloid metaplasia with an associated reactive fibrosis, angiogenesis, and osteosclerosis. However, marked myelofibrosis is not solely confined to PMF and may also be associated with other conditions including but not limited to acute megakaryoblastic leukemias (FAB AML-M7). Here, we describe a rare case of a non-megakaryoblastic acute myeloid leukemia with marked myelofibrosis with osteosclerosis and an isolated trisomy 19. A 19-year-old male presented with severe bone pain of one week duration with a complete blood cell count and peripheral smear showing a mild anemia and occasional circulating blasts. A follow up computed tomography (CT) scan showed diffuse osteosclerosis with no evidence of hepatosplenomegaly or lymphadenopathy. Subsequently, the bone marrow biopsy showed markedly sclerotic bony trabeculae and a hypercellular marrow with marked fibrosis and intervening sheets of immature myeloid cells consistent with myeloblasts with monocytic differentiation. Importantly, these myeloblasts were negative for megakaryocytic markers (CD61 and vWF), erythroid markers (hemoglobin and E-cadherin), and lymphoid markers (CD3, CD19, and TdT). Metaphase cytogenetics showed an isolated triosomy 19 with no JAK2 V617F mutation. The patient was treated with induction chemotherapy followed by allogenic hematopoietic stem cell transplantation which subsequently resulted in a rapid resolution of bone marrow fibrosis, suggesting graft-anti-fibrosis effect. This is a rare case of a non-megakaryoblastic acute myeloid leukemia with myelofibrosis and osteosclerosis with trisomy 19 that may provide insights into the prognosis and therapeutic options of future cases.
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Affiliation(s)
- Adam Stelling
- Department of Pathology and Laboratory Medicine, University of California Davis Medical Center, PATH Bldg. 4400 V Street, Sacramento, CA 95817, USA.
| | - Brian A Jonas
- Division of Hematology and Oncology, University of California Davis Medical Center, Sacramento, CA 95817, USA.
| | - Hooman H Rashidi
- Department of Pathology and Laboratory Medicine, University of California Davis Medical Center, PATH Bldg. 4400 V Street, Sacramento, CA 95817, USA.
| | - Mehrdad Abedi
- Division of Hematology and Oncology, University of California Davis Medical Center, Sacramento, CA 95817, USA.
| | - Mingyi Chen
- Department of Pathology and Laboratory Medicine, University of California Davis Medical Center, PATH Bldg. 4400 V Street, Sacramento, CA 95817, USA.
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12
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Tang VK, Huh YO, Tayar JH, Rojas Hernandez CM. Primary autoimmune myelofibrosis as etiology of pancytopenia mimicking myelodysplastic syndrome. Leuk Lymphoma 2015; 57:731-4. [DOI: 10.3109/10428194.2015.1076931] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Victoria K. Tang
- Department of Internal Medicine, The University of Texas Health Science Center, Houston, TX, USA,
| | - Yang O. Huh
- Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA,
| | - Jean H. Tayar
- Division of Internal Medicine, Section of Rheumatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, and
| | - Cristhiam M. Rojas Hernandez
- Division of Internal Medicine, Section of Benign Hematology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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13
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Raya JM, Montes-Moreno S, Acevedo A, Ferrández A, Fraga M, García JF, García M, Mayordomo-Aranda E, Menárguez J, Besses C, Calzada R, Rozman M. Pathology reporting of bone marrow biopsy in myelofibrosis; application of the Delphi consensus process to the development of a standardised diagnostic report. J Clin Pathol 2014; 67:620-5. [DOI: 10.1136/jclinpath-2014-202246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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