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Blood, 1 June 2002, Vol. 99, No. 11, pp. 4131-4137
NEOPLASIA
Diagnostic and prognostic value of bone marrow angiogenesis and
megakaryocyte c-Mpl expression in essential thrombocythemia
Ruben A. Mesa,
Curtis A. Hanson,
Chin-Yang Li,
Soo-Young Yoon,
S. Vincent Rajkumar,
Georgene Schroeder, and
Ayalew Tefferi
From the Division of Hematology and Internal Medicine,
the Division of Hematopathology, and the Cancer Center Statistics Unit,
Mayo Clinic, Rochester, MN.
The lack of diagnostic certainty in some patients makes it
difficult to distinguish between primary and secondary forms of thrombocytosis. To augment current diagnostic studies for
thrombocytosis, we retrospectively evaluated clinical records and bone
marrow trephine specimens of 183 patients with thrombocytosis 164 with essential thrombocythemia (ET), 19 with reactive thrombocytosis (RT)for bone marrow angiogenesis, bone marrow megakaryocyte c-Mpl staining, and morphologic evidence of megakaryocyte proliferation. Angiogenesis was increased in patients with ET compared with healthy controls (P < .0001) and patients with RT
(P = .006). In addition, an increase in angiogenesis was
associated with certain disease features such as splenomegaly
(P = .004) and reticulin fibrosis (P = .005). Decreased megakaryocyte c-Mpl staining was
observed in a heterogeneous pattern in ET compared with healthy
controls (P < .0001) and RT (P < .0001).
Histologic stratifying criteria incorporating increased angiogenesis,
decreased megakaryocyte c-Mpl expression, and marked
megakaryocyte proliferation in the bone marrow was highly
sensitive (97%) and specific (95%) for distinguishing ET from RT
(P < .0001). However, with the current duration of
follow-up available on the patients, none of the histologic features
evaluated have yet demonstrated prognostic value for subsequent
clinical course, vascular events, or survival.
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