Reticulin Fibrosis and Bone Infarction in Acute Leukemia. Implications for Prognosis

Reticulin fibrosis was found in 21 of 40 patients with acute lymphocytic leukemia when marrows were studied sequentially by Vim-Silverman needle biopsies. Reticulin fibrosis frequently occurred early in the development of the disease. Mild degrees were completely reversible with remission, severe degrees usually persisted, even through remissions. Fibrosis appeared to develop during relapse. Duration of the disease in itself had little influence on the degree of reticulin fibrosis, and collagen fibrosis seldom followed reticulin fibrosis even after many months’ duration. The prognosis of patients with reticulin fibrosis of their marrows was definitely poorer than for the group without increased reticulin. Reticulin fibrosis virtually always prevented successful marrow biopsies by the standard technic of needle aspiration. Bone necrosis occurred in 11 of 75 patients with acute lymphocytic leukemia, but in none of 53 patients with acute myelogenous leukemia studied by Vim-Silverman needle biopsies during life or at autopsy. Bone necrosis was the major cause of severe bone pain and it was always associated with reticulin fibrosis of the marrow. Bone infarcts were not associated with short survival in all cases, but in general the prognosis of patients with bone necrosis was even poorer than that of patients with reticulin fibrosis but without demonstrable infarction.