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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 3  |  Issue : 2  |  Page : 141-144

Patterns of haematological malignancies on bone marrow examination: A 3-year institutional experience


1 Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
2 Department of Clinical Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Submission10-Oct-2020
Date of Decision20-Apr-2022
Date of Acceptance18-Jul-2022
Date of Web Publication29-Aug-2022

Correspondence Address:
Dr. Harish Chandra
Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh - 249201, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JME.JME_127_20

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  Abstract 


Aims and Objectives: Haematological malignancy may show varied presentation in different regions of world, however, Uttarakhand lacks any recent data about them. The present study was therefore conducted to study the pattern of haematological malignancies on bone marrow examination in institute of Uttarakhand. Materials and Methods: This study was conducted at All India Institute of Medical Sciences, Rishikesh, Uttarakhand, over a period of 3 years. It included patients of haematological malignancies diagnosed on bone marrow examination. Patient's age, sex, clinical history and bone marrow diagnosis were noted for every case. All the data were entered into the excel sheet and statistically analysed. Results: The study included total 256 cases of haematological malignancies with male:female ratio of 1.13:1 and mean age of 39.3 years. Chronic myeloproliferative neoplasm (CMPN) was the most common haematological malignancy (49%) with chronic myeloid leukaemia (CML) being its most common type (40%). All the haematological malignancies showed male preponderance except for non-Hodgkin's lymphoma. Mean age of CMPN was 45.81 years and of acute myeloid leukaemia was 36.92 years. Bone marrow aspirate (BMA) and trephine biopsy (BMT) together were able to diagnose 81.3% of cases of haematological malignancies. Conclusion: The study concludes that haematological malignancies present at lesser age with male preponderance in Uttarakhand. CML is the most common haematological malignancy followed by acute lymphoblastic leukaemia. BMA and BMT are complimentary to each other for diagnosis of haematological malignancies and should be used together to avoid missing of any case.

Keywords: Bone marrow examination, chronic myeloid leukaemia, haematological malignancies, pattern


How to cite this article:
Chandra H, Kunnumbrath A, Bharati V, Singh N, Nath UK, Gupta AK. Patterns of haematological malignancies on bone marrow examination: A 3-year institutional experience. J Med Evid 2022;3:141-4

How to cite this URL:
Chandra H, Kunnumbrath A, Bharati V, Singh N, Nath UK, Gupta AK. Patterns of haematological malignancies on bone marrow examination: A 3-year institutional experience. J Med Evid [serial online] 2022 [cited 2022 Oct 5];3:141-4. Available from: http://www.journaljme.org/text.asp?2022/3/2/141/354980




  Introduction Top


Cancer is globally a major health problem with increased morbidity and mortality. Haematological malignancies are heterogeneous group of disease arising from malignant transformation of cells from the bone marrow or lymphatic system.[1] According to Globocan 2018 worldwide, the incidence rate of leukaemia is 2.4%, Non-Hodgkin's lymphoma (NHL) 2.8% and NHL is 0.44%.[2] In India, the incidence rate of leukaemia is comparatively higher of 3.6% and mortality rate of 4.1%.[2] Studies across India have observed varied incidence, aetiology and prognosis of haematological malignancies in different geographical areas.[3],[4] A study done about more than a decade ago in Uttarakhand, a north Himalayan state of India observed leukaemia followed by multiple myeloma (MM) as the common haematological malignancy.[5] Literature search lacks any recent data about the pattern of haematological malignancies prevalent in this region. It is therefore not only necessary to know the distribution of different leukemias and lymphomas but this knowledge would also be helpful in formulating an effective diagnostic, therapeutic and research base for haematological malignancies in this state of India.

The present study was therefore conducted to study the pattern of haematological malignancies on bone marrow examination in an Institute of Uttarakhand State of India. It was also intended to study if this distribution of malignancies is different from other regions of world.


  Materials and Methods Top


This study was conducted in the haematology section of the Pathology Department of All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India. The study was retrospectively conducted over a period of 3 years from 1 January 2017, to 31st December 2019, and included all the patients of haematological malignancies diagnosed on bone marrow examination (aspirate/biopsy or both). Patient's age, sex, residence, bone marrow indication, clinical history, relevant laboratory and radiological investigations along with bone marrow diagnosis were noted for every case. The bone marrow aspiration was primarily done from posterior superior iliac spine and the trephine biopsy was mostly performed in the same sitting. Imprint smears were also prepared from the biopsy and all the smears (aspiration and imprints) were aireints) and stained by May Grunwald Giemsa while biopsy sections were stained by haematoxylin and eosin stain and reticulin stain. Immunohistochemistry and flow cytometry was performed as and when required. All the data were entered in the excel sheet and statistically analysed using percentage, mean, median and standard deviation.


  Results Top


The study included total of 256 cases of haematological malignancies diagnosed on bone marrow examination over the period of 3 years. Males constituted 136 and females were 120 with male:female ratio of female ratio of 1.13:1. The mean age was 39.3 years and age range of 3–82 years. Out of the total cases, 191 were residents of neighbouring states while 65 cases were of Uttarakhand State. 21.5% (14/65) patients of Uttarakhand resided in hilly areas at height of 1000 m above sea level. [Table 1] shows the different haematological malignancies which were observed in the study. It shows that chronic myeloproliferative neoplasm (CMPN) was the most common haematological malignancy (49%) with chronic myeloid leukaemia (CML) being its most common type (40%). [Table 2] shows the age and sex distribution of the different haematological malignancies. It shows that almost all the haematological malignancies showed male preponderance except for NHL. It also shows that mean age of CMPN was 45.81 years and of acute myeloid leukaemia (AML) was 36.92 years. [Table 3] shows the number of cases diagnosed by bone marrow aspirate (BMA) or trephine biopsy (BMT). It shows that both BMA and BMT together were able to diagnose 81.3% of cases of haematological malignancies. Trephine biopsy was not performed in 34 cases either due to patient's reluctance or any other technical problems.
Table 1: Different types of haematological malignancies reported in the study

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Table 2: Age and sex distribution of different haematological malignancies

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Table 3: Bone marrow examination methods used for diagnosis of haematological malignancies

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  Discussion Top


Haematological malignancies are considered to be an important cause of malignancies worldwide and is the seventh most common malignancy in India.[2] It was observed in the present study that haematological malignancies were more common in males (male:female ratio of 1.13:1). Studies from other parts of world such as Bangladesh, Yemen and Nepal have also observed male preponderance.[6],[7],[8] This may be due to the fact that haematological malignancy are associated with potentially carcinogenic environmental agents and males are more exposed to them due to their occupations.[8] However, studies from Chile and Eritrean National Health laboratory have observed either female preponderance or gender equivalence in cases of haematological malignancies.[9],[10] It was observed in the present study that overall mean age of presentation was 39.3 years which was comparatively lesser as compared to other studies.[10] The mean age also varies with the type of malignancy and it was observed that acute lymphoblastic leukaemia (ALL) and AML were more commonly observed in younger age group while MM and NHL were disease of elderly age group. Although similar findings have also been observed by other studies but study done in Eastern Morocco observed lymphoma as most common haematological malignancy below 20 years of age group.[11] It has been suggested previously that variation in haematological malignancy with age may be due to increased precursor cells in immune system of young and preponderance of germinal centre and memory B cells in older age.[12]

A previous study from Uttarakhand region of India has observed that most common haematological malignancy observed was leukaemia 129/220 (58%) followed by lymphoma 33/220 (14.8%) and MM 55/220 (24.7%).[5] It was observed in the present study that CML was the most common haematological malignancy. This is an interesting observation as previously a study from Uttarakhand region observed AML as the most common haematological malignancy.[5] The probable reason may be that as this study was done about 15 years back so there may be changes in pattern of haematological malignancy over this extended period of time. Other studies from various countries also show different results. A study from Bangladesh has observed lymphoid neoplasm (60%) as the most common haematological malignancy followed by myeloid neoplasm (40%).[5] Similar findings were observed from other studies from Europe and Pakistan.[12],[13] The study from Eritrean National Health Laboratory has also found that acute leukaemia is the most common haematological malignancy followed by CML and chronic lymphocytic leukaemia.[9] These variations of our study from other studies around the world and as well as previous study from Uttarakhand is an important finding and may be helpful in formulating effective health strategy against haematological malignancies in this region.

Another important finding observed in the present study was 21.5% cases of this region resided in hilly areas above 1000 m above sea level. This in turn suggests that further research should be done to know the various environmental risk factors which may be associated with haematological malignancies in this high altitude.

The study also observed that the maximum number of cases was diagnosed when both BMA and BMT examination were used for the assessment of marrow. This suggests that aspiration and trephine are complimentary to each other for diagnosis of haematological examination on marrow and should be used together to avoid missing of any case of malignancy. This is necessary in cases where small focus of lymphoid neoplasm is present which may be diagnosed on BMT which may have been missed on BMA.[14]

An important limitation of the present study is that as it was conducted in a single institute, so it may have not given an exact number of haematological malignancies in the state. However, the results are important to give an estimate of disease burden with the prediction of age and gender of haematological malignancies in Uttarakhand state.


  Conclusion Top


The study concludes that haematological malignancies present at a lesser age with male preponderance in Uttarakhand region with substantial number residing at high altitudes of 1000 m above sea level. CML is the most common haematological malignancy followed by ALL which is in contrast to other studies. BMA and BMT are complimentary to each other for diagnosis of haematological malignancies and should be used together to avoid missing of any case. The awareness of pattern of haematological malignancies in this region would not only be helpful to clinicians and pathologists but also provide valuable information to the policymakers to improve the quality of health in this region of India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Flowers CR, Glover R, Lonial S, Brawley OW. Racial differences in the incidence and outcomes for patients with hematological malignancies. Curr Probl Cancer 2007;31:182-201.  Back to cited text no. 1
    
2.
World Health Organization. Global Health Observatory. Geneva: World Health Organization; 2018. Available from: who.int/gho/database/en/. [Last accessed on 2020 Jun 15].  Back to cited text no. 2
    
3.
Nair R, Arora N, Mallath MK. Epidemiology of non-Hodgkin's lymphoma in India. Oncology 2016;91 Suppl 1:18-25.  Back to cited text no. 3
    
4.
Prajapati Z, Kokani MJ, Gonsai RN. Clinicoepidemiological profile of hematological malignancies in pediatric age group in Ahmedabad. Asian J Oncol 2017;3:54-8.  Back to cited text no. 4
  [Full text]  
5.
Kusum A, Negi G, Gaur DS, Kishore S, Meena H, Sharma A, et al. Hematological malignancies diagnosed by bone marrow examination in a tertiary hospital at Uttarakhand, India. Indian J Hematol Blood Transfus 2008;24:7-11.  Back to cited text no. 5
    
6.
Ghartimagar D, Ghosh A, Narasimhan R, Talwar OP. Patterns of hematological and non-hematological malignancies in bone marrow in a tertiary care hospital in Nepal – 11 years study. Nepal Med Coll J 2012;14:187-92.  Back to cited text no. 6
    
7.
Hamid GA. The pattern of hematological malignancies at Al-Gamhouria teaching hospital, Aden, Yemen, from 2008 to 2010. Turk J Hematol 2012;29:342-7.  Back to cited text no. 7
    
8.
Sarwar MR, Lona H, Halder D, Selim S. Hematological malignancies pattern among Bangladeshi adults. J Med Sci Clin Res 2020;08:11-9. [doi: org/10.18535/jmscr/v8i5.02].  Back to cited text no. 8
    
9.
Pérez GB, Calaf GM, Villalba MT, Prieto KS, Burgos FC. Frequency of hematologic malignancies in the population of Arica, Chile. Oncol Lett 2019;18:5637-43.  Back to cited text no. 9
    
10.
Belai N, Ghebrenegus AS, Alamin AA, Alamin AA, Embaye G, Andegiorgish AK. Patterns of bone marrow aspiration confirmed hematological malignancies in Eritrean National Health Laboratory. BMC Hematol 2019;19:8.  Back to cited text no. 10
    
11.
Elidrissi Errahhali M, Elidrissi Errahhali M, Boulouiz R, Ouarzane M, Bellaoui M. Distribution and features of hematological malignancies in Eastern Morocco: A retrospective multicenter study over 5 years. BMC Cancer 2016;16:159.  Back to cited text no. 11
    
12.
Smith A, Howell D, Patmore R, Jack A, Roman E. Incidence of haematological malignancy by sub-type: A report from the Haematological Malignancy Research Network. Br J Cancer 2011;105:1684-92.  Back to cited text no. 12
    
13.
Khan S, Mir A, Khattak BR, Khan SN, Iqbal K, Malik SN. Pattern of adulthood hematological malignancies in Khyber Pakhtunkhwa. J Blood Disord Transfus 2018;10:424.  Back to cited text no. 13
    
14.
Chandra S, Chandra H. Comparison of bone marrow aspirate cytology, touch imprint cytology and trephine biopsy for bone marrow evaluation. Hematol Rep 2011;3:e22.  Back to cited text no. 14
    



 
 
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  [Table 1], [Table 2], [Table 3]



 

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