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Gunaratne MDSK, Shi M, Go RS. A comprehensive review on gelatinous transformation of the bone marrow. Expert Rev Hematol 2024. [PMID: 39060221 DOI: 10.1080/17474086.2024.2385472] [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: 11/16/2023] [Revised: 06/24/2024] [Accepted: 07/24/2024] [Indexed: 07/28/2024]
Abstract
INTRODUCTION Gelatinous transformation of the bone marrow (GTBM) represents a clinically significant but often underdiagnosed condition, emphasizing the pivotal role of accurate diagnosis in facilitating appropriate treatment strategies. AREAS COVERED This special report synthesizes insights gathered from a comprehensive appraisal of clinical and pathology publications on GTBM available on PubMed. By employing search terms such as 'gelatinous,' 'gelatinous transformation,' and 'bone marrow,' this report aims to provide a nuanced understanding of GTBM, elucidating distinctive pathological features while distinguishing it from similar pathologies. The review also discusses currently identified causes of GTBM, clinical, imaging, pathologic and laboratory findings that are associated with GTBM, and treatment options available. EXPERT OPINION Contrary to popular belief, we suggest that nutrient deficiency is not solely responsible for the pathogenesis of GTBM and that malignancies, infection, and inflammatory conditions plays a critical role in its pathogenesis. We propose that further research on the pathophysiology of GTBM should be performed to unravel the complex interplay of nutritional and inflammatory factors in hematopoiesis, paving the way for innovative treatment approaches in hematopoietic disorders. To better facilitate further research in GTBM, we suggest formulating a pooled patient database with nutritional, genetic, and cytokine markers in a prospective fashion.
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Affiliation(s)
| | - Min Shi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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Hahn LA, Torlakovic E, Bosch M. Gelatinous Transformation of Bone Marrow Following Lymphoma and a Novel, Potential Treatment. Cureus 2024; 16:e59354. [PMID: 38817486 PMCID: PMC11138238 DOI: 10.7759/cureus.59354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
Gelatinous transformation of bone marrow (GTBM) is a rare hematologic condition in which hematopoietic cells in the bone marrow are replaced by extracellular gelatinous substances, often resulting in cytopenias. The true incidence of this condition is presently unknown, as the current body of literature primarily consists of case reports. However, an analysis of a large bone marrow registry suggests that this is a highly rare entity even among a population requiring bone marrow biopsy. We present a case of a 24-year-old man with a history of diffuse large B cell lymphoma and an associated 45-kilogram weight loss, who was later found to have GTBM. The extent of his cytopenias resulted in a prolonged hospitalization with numerous complications, eventually leading to experimental treatment with allogeneic stem cell transplantation (ASCT). To our knowledge, this is the first reported case of GTBM in which ASCT was employed as a potential treatment modality. While our patient did have clinical improvement following ASCT, the permanence of these results is presently unclear. Furthermore, it is uncertain if the ASCT was truly causative of the stabilization of the patient. Given this, we are currently unable to advocate for ASCT as a treatment for GTBM. We report this case to raise awareness of this rare entity in the context of refractory cytopenias.
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Affiliation(s)
- Logan A Hahn
- Internal Medicine, University of Saskatchewan, Saskatoon, CAN
| | | | - Mark Bosch
- Hematology, Saskatchewan Cancer Agency, Saskatoon, CAN
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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.
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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
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Lompardía S, Díaz M, Pibuel M, Papademetrio D, Poodts D, Mihalez C, Álvarez É, Hajos S. Hyaluronan abrogates imatinib-induced senescence in chronic myeloid leukemia cell lines. Sci Rep 2019; 9:10930. [PMID: 31358779 PMCID: PMC6662747 DOI: 10.1038/s41598-019-47248-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/12/2019] [Indexed: 12/12/2022] Open
Abstract
Hyaluronan (HA) is the main glycosaminoglycan of the extracellular matrix. CD44 is the most important HA receptor, and both have been associated with poor prognosis in cancer. Chronic myeloid leukemia (CML) is characterized by the presence of a constitutively activated tyrosine kinase (Breakpoint Cluster Region - Abelson murine leukemia viral oncogene homolog1, BCR-ABL). It is mainly treated with BCR-ABL inhibitors, such as imatinib. However, the selection of resistant cells leads to treatment failure. The aim of this work was to determine the capacity of HA (high molecular weight) to counteract the effect of imatinib in human CML cell lines (K562 and Kv562). We demonstrated that imatinib decreased HA levels and the surface expression of CD44 in both cell lines. Furthermore, HA abrogated the anti-proliferative and pro-senescent effect of Imatinib without modifying the imatinib-induced apoptosis. Moreover, the inhibition of HA synthesis with 4-methylumbelliferone enhanced the anti-proliferative effect of imatinib. These results suggest that Imatinib-induced senescence would depend on the reduction in HA levels, describing, for the first time, the role of HA in the development of resistance to imatinib. These findings show that low levels of HA are crucial for an effective therapy with imatinib in CML.
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Affiliation(s)
- Silvina Lompardía
- Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología, Cátedra de Inmunología, Buenos Aires, Argentina.
- Universidad de Buenos Aires, CONICET, Instituto de Estudios de la Inmunidad Humoral (IDEHU), Buenos Aires, Argentina.
| | - Mariángeles Díaz
- Universidad de Buenos Aires, CONICET, Instituto de Estudios de la Inmunidad Humoral (IDEHU), Buenos Aires, Argentina
| | - Matías Pibuel
- Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología, Cátedra de Inmunología, Buenos Aires, Argentina
- Universidad de Buenos Aires, CONICET, Instituto de Estudios de la Inmunidad Humoral (IDEHU), Buenos Aires, Argentina
| | - Daniela Papademetrio
- Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología, Cátedra de Inmunología, Buenos Aires, Argentina
- Universidad de Buenos Aires, CONICET, Instituto de Estudios de la Inmunidad Humoral (IDEHU), Buenos Aires, Argentina
| | - Daniela Poodts
- Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología, Cátedra de Inmunología, Buenos Aires, Argentina
| | - Cintia Mihalez
- Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología, Cátedra de Inmunología, Buenos Aires, Argentina
- Universidad de Buenos Aires, CONICET, Instituto de Estudios de la Inmunidad Humoral (IDEHU), Buenos Aires, Argentina
| | - Élida Álvarez
- Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología, Cátedra de Inmunología, Buenos Aires, Argentina
- Universidad de Buenos Aires, CONICET, Instituto de Estudios de la Inmunidad Humoral (IDEHU), Buenos Aires, Argentina
| | - Silvia Hajos
- Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología, Cátedra de Inmunología, Buenos Aires, Argentina
- Universidad de Buenos Aires, CONICET, Instituto de Estudios de la Inmunidad Humoral (IDEHU), Buenos Aires, Argentina
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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]
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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.
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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.
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Das S, Mishra P, Kar R, Basu D. Gelatinous marrow transformation: a series of 11 cases from a tertiary care centre in South India. Turk J Haematol 2014; 31:175-9. [PMID: 25035676 PMCID: PMC4102046 DOI: 10.4274/tjh.2012.0151] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 05/06/2013] [Indexed: 12/01/2022] Open
Abstract
Gelatinous marrow transformation (GMT) or serous atrophy of bone marrow (BM) is a rare disease characterised by focal marrow hypoplasia, fat atrophy, and accumulation of extracellular mucopolysaccharides abundant in hyaluronic acid. This study reviews 11 cases of GMT from South India. Clinical and haematological parameters, BM aspirate, and biopsies of all patients diagnosed with GMT over a period of 7 years were studied. GMT was diagnosed in BM biopsy based on characteristic morphological appearance and was confirmed by alcian blue positive staining pattern at pH levels of 2.5 and 0.5. Eleven patients were diagnosed with GMT. All were males within the age range of 15 to 50 years. The underlying clinical diagnosis was human immunodeficiency virus positivity in 5 cases, 2 with coexistent disseminated tuberculosis, 1 with cryptococcal meningitis, and 1 with oral candidiasis; disseminated tuberculosis in 1 case; pyrexia of unknown origin in 2 cases; Hodgkin’s lymphoma in 1 case; acute lymphoblastic lymphoma with maintenance chemotherapy in 1 case; and alcoholic pancreatitis in 1 case. BM aspirates showed gelatinous metachromatic seromucinous material in 3 cases. BM biopsies were hypocellular in 7 and normocellular in 4 cases and showed focal GMT in 5 and diffuse GMT in 6 cases. Reactive changes were seen in 4 cases and haemophagocytosis in addition to GMT in 1 case. GMT is a relatively uncommon condition and an indicator of severe illness. It should be differentiated from myelonecrosis, amyloidosis, and marrow oedema. A high index of suspicion is required to diagnose this condition.
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Affiliation(s)
- Sreeya Das
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Department of Pathology, Puducherry, India
| | - Pritinanda Mishra
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Department of Pathology, Puducherry, India
| | - Rakhee Kar
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Department of Pathology, Puducherry, India
| | - Debdatta Basu
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Department of Pathology, Puducherry, India
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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
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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
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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]
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