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Prognostic impact of vascular density and fibrosis in the bone marrow of children with high-risk acute lymphoblastic leukemia.
Umeå University, Faculty of Medicine, Medical Biosciences, Pathology. Patologi.
Umeå University, Faculty of Medicine, Medical Biosciences, Pathology. Patologi.
Umeå University, Faculty of Medicine, Medical Biosciences, Pathology. Patologi.
Umeå University, Faculty of Medicine, Clinical Sciences, Paediatrics. Pediatrik.
2005 (English)In: Leukemia, ISSN 0887-6924, Vol. 19, no 11, 1998-2001 p.Article in journal (Other academic) Published
Place, publisher, year, edition, pages
2005. Vol. 19, no 11, 1998-2001 p.
Keyword [en]
Adolescent, Biopsy, Bone Marrow/blood supply/pathology, Child, Child; Preschool, Female, Fibrosis, Humans, Infant, Leukemia; Lymphocytic; Acute/*pathology, Male, Microcirculation, Neovascularization; Pathologic, Prognosis, Reticulin, Risk Assessment
URN: urn:nbn:se:umu:diva-15228DOI: 10.1038/sj.leu.2403953PubMedID: 16179911OAI: diva2:154900
Available from: 2008-06-24 Created: 2008-06-24Bibliographically approved
In thesis
1. Vascular density and bone marrow fibrosis in childhood acute lymphoblastic leukemia
Open this publication in new window or tab >>Vascular density and bone marrow fibrosis in childhood acute lymphoblastic leukemia
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: In childhood acute lymphoblastic leukemia (ALL), the cure rate has now reached 80% in the western world. Even so, 15¬–20% will die from the disease or treatment-related causes, among them children who did not present any known unfavorable features at diagnosis. Treatment of childhood ALL is risk-adapted, meaning that certain factors that are related to the child or the leukemic blasts stratifies to more or less intensive treatment. In this thesis, characteristics of the bone marrow (BM) stroma, reflecting the interaction between the leukemic cells and their microenvironment, were evaluated. The aims were to investigate these factors in relation to other known data in order to further understand the biology of leukemia, and to suggest additional risk factors that would further improve decision making for the treatment of individual children diagnosed with ALL.

Methods: We retrospectively investigated microvessel density (MVD), blast-congested vessel fraction (BCVF), and degree of fibrosis – reticulin fiber density (RFD) – in sections from diagnostic BM biopsies from children diagnosed in Umeå, Uppsala, and Stockholm. RFD was also studied in BM sections from treatment day 29.

Results: RFD had prognostic impact in patients with high-hyperdiploid (HeH) leukemia. Moreover, rapid reduction of RFD during induction treatment was associated with a favorable prognosis compared to slow reduction, in B-cell precursor (BCP) ALL patients. There was also a correlation between RFD at diagnosis and minimal residual disease (MRD) measured by flow cytometry on treatment day 29 in BCP patients.

BCP patients with high RFD and high MVD had an unfavorable outcome compared to all other BCP patients. In addition, MVD and RFD were both associated with immunophenotype, and MVD with cytogenetic aberrations. There was a correlation between MVD and WBC count in BCP high-risk patients. There was also a strong correlation between BCVF and WBC count in all BCP patients, but not between BCVF and MVD or RFD.

There was a negative correlation between MVD and in vitro cellular resistance to several drugs in BCP patients. A drug-resistance score combining the drugs most strongly correlated to MVD – cytarabine, doxorubicin, and dexametasone (ADD score) – identified the prognostic potential of ADD score in HeH patients with no unfavorable features.

Conclusions: Taken together, these studies indicate that stroma factors in leukemia are related to both phenotypic and genotypic features of acute leukemia. Stroma factors also seem to influence the response to induction treatment, in vitro drug resistance, and outcome in certain subgroups of childhood ALL patients. The results emphasize the importance of BM stroma in leukemia and the need for greater use of BM biopsy at diagnosis.

Place, publisher, year, edition, pages
Umeå: Pediatrik, 2008. 51 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1183
Childhood acute lymphoblastic leukemia, microvessel density, bone marrow fibrosis, in vitro drug resistance, minimal residual disease, outcome
National Category
Cancer and Oncology
urn:nbn:se:umu:diva-1642 (URN)978-91-7264-572-1 (ISBN)
Public defence
2008-05-30, Sal Betula, 6M, Norrlands Universitetssjukhus, 901 85 UMEÅ, 13:00 (English)
Available from: 2008-05-09 Created: 2008-05-09 Last updated: 2010-01-18Bibliographically approved

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