1
|
Kataoka H, Tomita T, Kondo M, Makita K, Tsuji T, Mukai M. Autopsy of a case of rheumatoid arthritis with severe bicytopoenia due to gelatinous transformation of the bone marrow. Mod Rheumatol Case Rep 2021; 5:236-240. [PMID: 33970059 DOI: 10.1080/24725625.2021.1913278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We present the case of an elderly female patient with rheumatoid arthritis (RA) treated with methotrexate. She was referred to our hospital with severe malaise. She was emaciated and had massive pleural effusion that induced atelectasis. Her blood tests revealed elevated CRP, leukopenia, and severe anaemia. She lost consciousness on the third day of hospital stay and passed away the following day. Her autopsy showed gelatinous transformation of the bone marrow that gave rise to bicytopoenia, whereas there were no other causes for severe anaemia. Bone marrow gelatinous transformation can cause impaired haematopoiesis in elderly RA patients.
Collapse
Affiliation(s)
- Hiroshi Kataoka
- Department of Rheumatology and Clinical Immunology, Sapporo City General Hospital, Hokkaido, Japan
| | - Tomoko Tomita
- Department of Rheumatology and Clinical Immunology, Sapporo City General Hospital, Hokkaido, Japan
| | - Makoto Kondo
- Department of Rheumatology and Clinical Immunology, Sapporo City General Hospital, Hokkaido, Japan
| | - Keishi Makita
- Department of Pathology, Sapporo City General Hospital, Hokkaido, Japan
| | - Takahiro Tsuji
- Department of Pathology, Sapporo City General Hospital, Hokkaido, Japan
| | - Masaya Mukai
- Department of Rheumatology and Clinical Immunology, Sapporo City General Hospital, Hokkaido, Japan
| |
Collapse
|
2
|
Malki S, Miry A, Karich N, Bennani A. [Bone marrow serous degeneration complicating acute leukemia]. Ann Pathol 2020; 40:316-319. [PMID: 32340756 DOI: 10.1016/j.annpat.2020.02.013] [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: 12/23/2019] [Accepted: 02/10/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Serous degeneration of bone marrow is a rare hematological complication, of multiple etiologies, which physiopathology is yet to be fully understood. It is described as a focal hypoplasia of the bone marrow and atrophy of its adipocytes coupled with an extracellular deposit of an eosinophilic substance that corresponds to "hyaluronic acid". The prognosis of these lesions depends on the etiological diagnosis. OBSERVATION We report the case of a 19-year-old female patient without no notable pathological history, hospitalized in a regional hospital for mucocutaneous pallor with an impaired general condition. The biological assessment revealed a pancytopenia, and the presence of 60 % blast cells on the blood smear, which was in favor of acute leukemia. As part of the etiological assessment, a bone marrow biopsy was performed, revealing a typical aspect of serous degeneration. The bone marrow cellularity was reduced, made of rare hematopoietic cells, dissociated by pale extracellular deposits that were colored by PAS and alcian blue, with no individualized blasts. DISCUSSION Serous transformation of the hematopoietic marrow is a rare condition, described at the end of the 19th century. The most severe forms are observed in young patients with hypoplasia. It most often manifests as pancytopenia at the beginning, if not then by an isolated cytopenia, anemia or thrombocytopenia. It is interesting to underline the contribution of MRI in diagnosis. The foci of bone marrow serous degeneration are characterized in the long bones by a fluid signal with a T1 hypo-signal and a T2 hyper-signal with no enhancement after injection of gadolinium, unlike bone metastases. The histology of bone marrow biopsy finds focal marrow hypoplasia of the hematopoietic lines associated with a depletion of adipocytes and an eosinophilic gelatinous interstitial infiltration alcian blue and PAS positive. The histological differential diagnosis is amyloidosis due to red Congo positivity, a previous biopsy (the absence of adipose tissue or hematopoietic tissue with granulation tissue and bone formation) and interstitial edema. Bone marrow necrosis can also be observed. Serous degeneration of bone marrow can be a symptom of a chronic systemic illness. In most cases, it is found in cases of severe chronic malnutrition, such as anorexia nervosa, certain cancers (acute leukemia), systemic diseases (lupus) or severe infection. Though there is no specific treatment for this complication, the treatment of the cause most often allows for the complete regression of the peripheral and spinal anomalies. CONCLUSION In rare cases, as is the case in our observation, the serous degeneration of bone marrow can reveal underlying solid tumors or hemopathies, knowledge of it can help guide the investigations towards these etiologies.
Collapse
Affiliation(s)
- Samia Malki
- Service d'anatomie et de cytologie pathologique, Mohamed VI, Oujda, Maroc.
| | - Achraf Miry
- Service d'anatomie et de cytologie pathologique, Mohamed VI, Oujda, Maroc
| | - Nassira Karich
- Service d'anatomie et de cytologie pathologique, Mohamed VI, Oujda, Maroc
| | - Amal Bennani
- Service d'anatomie et de cytologie pathologique, Mohamed VI, Oujda, Maroc
| |
Collapse
|
3
|
Gelatinous bone marrow transformation and emergence of clonal Philadelphia-negative cytogenetic abnormalities with excess blasts in a patient with chronic myeloid leukemia treated with dasatinib. Anticancer Drugs 2019; 30:416-421. [DOI: 10.1097/cad.0000000000000763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
4
|
Ethnic Differences in Hematologic Toxicity from Imatinib in Patients with Gastrointestinal Stromal Cell Tumor (GIST): Coincidence or a Real Phenomenon. EURASIAN JOURNAL OF MEDICINE AND ONCOLOGY 2019; 3:182-185. [PMID: 32104790 PMCID: PMC7043204 DOI: 10.14744/ejmo.2019.94710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objectives: There is a wide variability in the pharmacokinetics, pharmacodynamics and tolerance of anticancer drugs based on ethnicity. GIST is a rare cancer, (~1% of GI cancers). Imatinib is used in the neo-adjuvant, adjuvant and metastatic setting. The purpose of this study was to report the difference in hematologic toxicities to imatinib among different ethnicities when treated for GIST either in the adjuvant or metastatic setting. Methods: We performed a retrospective study to collect data on patients with GIST (in any stage), who were on imatinib and presenting with grade 2 or more anemia, neutropenia and/or thrombocytopenia from July 1, 2005 to January 31, 2018. The degree of cytopenia was graded as per National Cancer Institute Common Toxicity criteria; version 4.0. We collected included age, gender, ethnicity, pathology, adverse effects-hematologic and non-hematologic, management of toxicities including dose modifications and administration of pegfilgrastim. Results: Among 57 patients (median age 61 years, M: F=41:16 (F); ethnicities: White 65%, African-American (AA 19%, Asian 12% and Hispanic 4%), neutropenia (Grade 3 & 4) was seen in 6 patients (10%): 5 AA and 1 Asian. 45% of all AA patients developed neutropenia. Median absolute neutrophil count (ANC) nadir was 700/μL, median duration on drug prior to onset of neutropenia was 4.5 weeks and median duration of neutropenia was 4 weeks. One patient developed febrile neutropenia. Dose interruptions were needed in 3, dose-reductions in all patients, and 3 patients required pegfilgrastim. One patient had to discontinue imatinib, while one patient was escalated back to 400mg daily dose. Conclusion: This is the first study to examine ethnic variations in myelosuppression following imatinib in patients with GIST.
Collapse
|
5
|
Shergill KK, Shergill GS, Pillai HJ. Gelatinous transformation of bone marrow: rare or underdiagnosed? AUTOPSY AND CASE REPORTS 2017; 7:8-17. [PMID: 29259927 PMCID: PMC5724049 DOI: 10.4322/acr.2017.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 10/24/2017] [Indexed: 12/21/2022] Open
Abstract
Gelatinous transformation of the bone marrow (GTBM) is a rare hematologic entity, which was first described by Paul Michael in 1930. GTBM is mostly associated with caloric intake/anorexia nervosa, although it also has been described accompanying other pathologic conditions, such as malignancy, systemic lupus erythematosus, HIV infections. Even though the diagnostic features of the hematopoietic tissue, such as hypoplasia, adipose cell atrophy, and deposition of a gelatinous substance in the bone marrow (which stains with Alcian blue at pH 2.5) are quite specific, the underlying pathogenic mechanisms remain poorly understood. Considering the evidence of reversibility—notably in cases of malnutrition and anorexia—this entity should be kept high on cards as a possible differential diagnosis of patients presenting with cytopenias and associated weight loss or starvation, especially in developing countries with nutritionally deprived populations. On an extensive review of the literature aimed at comprehensively addressing the evolution of the GTBM from the past century until now, we conclude that the lack of clinical suspicion and awareness regarding this pathologic entity has led to misdiagnosis and delayed diagnosis.
Collapse
|
6
|
Gelatinous Marrow Transformation Associated with Imatinib: Case Report and Literature Review. Case Rep Hematol 2017; 2017:1950724. [PMID: 28133556 PMCID: PMC5241459 DOI: 10.1155/2017/1950724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 12/14/2016] [Indexed: 11/23/2022] Open
Abstract
Gelatinous marrow transformation (GMT) is a rare condition observed in severe illness or malnutrition, in which the bone marrow contains amorphous “gelatinous” extracellular material, and histopathology demonstrates varied degrees of fat cell atrophy and loss of hematopoietic elements. An association of GMT with imatinib use in chronic myeloid leukemia (CML) has been reported recently. The objective of this study is to describe a case of GMT associated with imatinib use and review the existing similar cases in the literature to identify epidemiological patterns and potential imatinib-induced mechanisms leading to gelatinous conversion.
Collapse
|
7
|
[Gelatinous transformation of the bone marrow: A retrospective monocentric case series of 12 patients]. Rev Med Interne 2015; 37:448-52. [PMID: 26632481 DOI: 10.1016/j.revmed.2015.10.349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 07/01/2015] [Accepted: 10/24/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Gelatinous bone marrow transformation is a rare complication of unknown pathogenesis related to several underlying diseases. It is described as a focal loss of hematopoietic cells and a deposition of eosinophilic gelatinous substance rich in hyaluronic acid. We report a retrospective monocentric study followed by a literature review. METHODS We have identified 12 patients with gelatinous transformation from 1999 to 2014. Clinical, biological and cytological data were collected. RESULTS A bone marrow aspirate was performed for mild to severe pancytopenia (50%), less frequently for monocytopenia. Mean haemoglobin was 10.4g/dL, platelets 126.9G/L and leucocytes 3.82G/L. Gelatinous transformation was found in all patients. We have identified three hematologic malignancies, three cancers, three severe infections, two anorexia nervosa and one kidney injury. Ten patients had undernutrition, 9 out of the 12 patients died within a year due to advanced underlying disease and comorbidities. CONCLUSION Gelatinous bone marrow transformation is found in various situations of severe undernutrition including anorexia nervosa, advanced cancers or severe sepsis, especially in HIV infection. The deposition of hyaluronic acid probably reduces haematopoiesis. Due to a complex inflammatory process, it alters the hematopoietic microenvironment and the bone marrow stroma. Severe undernutrition and other mechanisms are reviewed in this study. Gelatinous degeneration is still a rare disorder, indicative of an advanced underlying disease; its recognition could help guide investigations.
Collapse
|
8
|
Gelatinous Marrow Transformation in an Imatinib-Treated CML Patient with Pancytopenia Following Severe Sepsis. Indian J Hematol Blood Transfus 2014; 30:72-4. [PMID: 24554832 DOI: 10.1007/s12288-012-0188-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 08/08/2012] [Indexed: 10/28/2022] Open
|
9
|
Sharma SK, Choudhary D, Handoo A, Kharya G, Gupta N, Pavecha P, Chadha R. Gelatinous transformation of bone marrow following the use of dasatinib in a patient with philadelphia chromosome-positive acute lymphoblastic leukemia. Leuk Res Rep 2013; 2:7-8. [PMID: 24371767 DOI: 10.1016/j.lrr.2012.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sanjeev Kumar Sharma
- Department of Hemato-oncology and Bone Marrow Transplant, BL Kapur Superspeciality Hospital, Pusa Road, New Delhi, India
| | - Dharma Choudhary
- Department of Hemato-oncology and Bone Marrow Transplant, BL Kapur Superspeciality Hospital, Pusa Road, New Delhi, India
| | - Anil Handoo
- Department of Hemato-oncology and Bone Marrow Transplant, BL Kapur Superspeciality Hospital, Pusa Road, New Delhi, India
| | - Gaurav Kharya
- Department of Hemato-oncology and Bone Marrow Transplant, BL Kapur Superspeciality Hospital, Pusa Road, New Delhi, India
| | - Nitin Gupta
- Department of Hemato-oncology and Bone Marrow Transplant, BL Kapur Superspeciality Hospital, Pusa Road, New Delhi, India
| | - Punita Pavecha
- Department of Hemato-oncology and Bone Marrow Transplant, BL Kapur Superspeciality Hospital, Pusa Road, New Delhi, India
| | - Ritu Chadha
- Department of Hemato-oncology and Bone Marrow Transplant, BL Kapur Superspeciality Hospital, Pusa Road, New Delhi, India
| |
Collapse
|
10
|
Srinivas BH, Paul TR, Uppin SG, Uppin MS, Jacob RT, Raghunadharao D. Morphologic Changes in the Bone Marrow in Patients of Chronic Myeloid Leukemia (CML) Treated with ImatinibMesylate. Indian J Hematol Blood Transfus 2012; 28:162-9. [PMID: 23997453 PMCID: PMC3422382 DOI: 10.1007/s12288-011-0136-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Accepted: 12/08/2011] [Indexed: 11/29/2022] Open
Abstract
Imatinib mesylate (Gleevec) is an effective treatment for chronic myeloid leukemia (CML). Though cytogenetic and molecular analyses are essential disease monitoring parameters in CML bone marrow morphological response is not well defined. We examined marrow samples from 40 patients with CML which have at least 2 or more follow-up marrow. A significant positive correlation with complete cytogenetic response shown for normalization of cellularity (P = 0.0097), absence of dry tap (P = 0.0368) and abnormal megakaryocytes (P = 0.005), reduction of blasts (P = 0.019), basophils (P = 0.031), M:E index (P = 0.018) and fibrosis (P = 0.018). Morphological criteria for complete cytogenetic response in CML patients treated with Imatinib can be defined.Morphologic response is also of potential clinical value in addition to cytogenetic and molecular response in patients of CML treated with Imatinib.
Collapse
Affiliation(s)
- B. H. Srinivas
- Department of Pathology, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, 500082 India
| | - T. Roshni Paul
- Department of Pathology, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, 500082 India
| | - Shantveer G. Uppin
- Department of Pathology, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, 500082 India
| | - Megha S. Uppin
- Department of Pathology, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, 500082 India
| | - Rachel T. Jacob
- Department of Pathology, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, 500082 India
| | - D. Raghunadharao
- Department of Medical Oncology, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, 500082 India
| |
Collapse
|
11
|
Prodduturi P, Perry AM, Aoun P, Weisenburger DD, Akhtari M. Recurrent bone marrow aplasia secondary to nilotinib in a patient with chronic myeloid leukemia: A case report. J Oncol Pharm Pract 2012; 18:440-4. [DOI: 10.1177/1078155212438112] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nilotinib is a potent tyrosine kinase inhibitor of breakpoint cluster region-abelson (BCR-ABL), which has been approved as front-line therapy for newly diagnosed chronic myeloid leukemia in chronic phase and as second-line therapy after imatinib failure in chronic or accelerated phase chronic myeloid leukemia. Tyrosine kinase inhibitors have been associated with myelosuppression and grade 3 or grade 4 cytopenias are not uncommon in chronic myeloid leukemia patients treated with these drugs. There are a few reports of imatinib-associated bone marrow aplasia, but to our knowledge only one reported case of bone marrow aplasia associated with nilotinib. Herein, we report a 49-year-old male patient with chronic phase chronic myeloid leukemia, who developed severe bone marrow aplasia due to nilotinib. Possible mechanisms for this significant adverse drug reaction are discussed along with a review of literature.
Collapse
Affiliation(s)
- Prathima Prodduturi
- Department of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Anamarija M Perry
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Patricia Aoun
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dennis D Weisenburger
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mojtaba Akhtari
- Department of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
12
|
Bone marrow with gelatinous transformation associated with residual disease in imatinib mesylate-treated chronic myelogenous leukaemia (CML). Pathology 2011; 44:59. [PMID: 22157697 DOI: 10.1097/pat.0b013e32834e42df] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
Barber NA, Afzal W, Akhtari M. Hematologic toxicities of small molecule tyrosine kinase inhibitors. Target Oncol 2011; 6:203-15. [PMID: 22127751 DOI: 10.1007/s11523-011-0202-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 11/08/2011] [Indexed: 12/15/2022]
Abstract
Small molecule tyrosine kinase inhibitors (TKIs) are potent anti-cancer targeted therapies. TKIs are considered safe and efficacious therapeutic modalities, and are generally tolerated well. However, they are associated with certain side effects including hematologic toxicities such as anemia, macrocytosis, neutropenia, thrombocytopenia, hemolytic anemia, bone marrow aplasia and necrosis. Thrombotic microangiopathy, arterial thromboembolism and splenic infarction can also occur following treatment with TKIs. Cytopenias are the most common adverse effects associated with these agents, and other hematologic toxicities are not frequent. It is essential for clinicians to monitor patients closely, and recognize those side effects as early as possible, in order to improve efficacy of small molecule TKIs and optimize outcomes. This article summarizes hematologic toxicities associated with the commonly used small molecule TKIs. It also provides practical strategies for the management of these toxicities.
Collapse
Affiliation(s)
- Nicholas A Barber
- Division of Hematology and Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, USA
| | | | | |
Collapse
|
14
|
Paul TR, Uppin SG, Uppin MS, Jacob RT, Rao DR, Rajappa SJ. Evaluation of Cytopenias Occurring in Imatinib Treated Chronic Myeloid Leukemia (CML) Patients. Indian J Hematol Blood Transfus 2010; 26:56-61. [PMID: 21629637 DOI: 10.1007/s12288-010-0030-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 08/30/2010] [Indexed: 11/28/2022] Open
Abstract
Imatinib Mesylate, a Tyrosine Kinase inhibitor, is presently the drug of choice for Chronic myeloid leukemia (CML). During therapy, a few patients develop myelosuppression and present with cytopenias. To study the bone marrow morphology in imatinib treated CML patients presenting with persistent cytopenias. The cases were retrieved from the Hematopathology record files, Department of Pathology; the study period being January 2008-June 2009. Cases of CML on Imatinib presenting with grade 2 or more anemia, neutropenia and/or thrombocytopenias with bone marrow studies, were included in the study. The morphology of all cases was reviewed with cytogenetic studies. Follow-up details were obtained from the Medical Oncology records. During the study period, 683 Imatinib treated CML patients had bone marrow studies as part of their follow-up investigations. Of these, 60 patients (9%) had some form of persistent cytopenia. The patients ranged from 21 to 75 years of age with a median age of 38 years. The male:female ratio was 1:1. There were 46 patients with ≥grade 2 anemia, 25 patients with ≥grade 2 neutropenia and 37 patients with ≥grade 2 thrombocytopenia. Of these, 18 patients had bicytopenia and 13 cases had pancytopenia. The marrow evaluation revealed morphologic response in 30 patients, persistent marrow disease in five patients, marrow hypoplasia in six patients, extensive stromal changes including fibrosis in five patients, megaloblastic erythropoiesis in 11 patients and disease progression to accelerated or blast crisis in three patients. Various degrees of cytopenias may occur in few patients of CML on imatinib therapy. Regular hematologic follow-up is required so that the drug may be stopped or dose modified as per the individual's needs.
Collapse
|
15
|
Hong FS, Mitchell CA, Zantomio D. Gelatinous transformation of the bone marrow as a late morphological change in imatinib mesylate treated chronic myeloid leukaemia. Pathology 2010; 42:84-5. [DOI: 10.3109/00313020903434686] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
16
|
Song MK, Choi YJ, Seol YM, Shin HJ, Chung JS, Cho GJ, Lee EY. Nilotinib-induced bone marrow aplasia. Eur J Haematol 2009; 83:161-2. [DOI: 10.1111/j.1600-0609.2009.01269.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|