OBJECTIVE: Inflammatory rheumatic diseases and the applied immunosuppressive treatments can lead to bone marrow depressions and promote hematologic malignancies. Our objective was to explore indications for and results of bone marrow examinations in a large cohort. METHODS: Between 1990 and 2004 146 bone marrow examinations in 3638 patients were performed due to abnormal laboratory results. Medical history, results of bone marrow examination (morphology, histology) and cytogenetic data were investigated retrospectively. RESULTS: Patients' (67.8% female) mean age at bone marrow examination was 53.5 years (SD 15.5), median disease duration 2.9 years. Indications for bone marrow examination were changes in peripheral blood counts in 81.7%. In 52 patients (35.6%) clinically relevant, partially neoplastic bone marrow changes (5 non-Hodgkin lymphoma, 9 myelodysplastic syndromes (MDS)/acute myeloid leukemia (AML) and 3 myeloproliferative neoplasias) were evident. Medication history showed intake of hydroxy-/chloroquine (13.5%), methotrexate (17.3%), cyclosporin (7.7%), sulfasalazine (7.7%), mycophenolatmofetil, gold, leflunomide (each 1.9%), azathioprine (aza, 25.0%) or cyclophosphamide (cyc, 7.7%) prior to bone marrow examination. 7 out of 9 patients, who developed MDS/AML had been treated with either azathioprine alone or additionally with cyclophosphamide (n = 3). CONCLUSION: One third of our patients showed relevant bone marrow changes that might be associated to therapy. The risk seems to be increased especially in patients with inflammatory rheumatic diseases who had received azathioprine alone or in combination with cyclophosphamide. Health care providers should bear in mind the risk of hematologic malignancies and monitor patients closely in this respect. Bone marrow examination should be performed in case of changes in peripheral blood counts; especially clinically relevant anemia, granulocytes < 2,500/microl, thrombocytes < 100,000/microl and relevant changes over time should lead to bone marrow examinations.
OBJECTIVE: Inflammatory rheumatic diseases and the applied immunosuppressive treatments can lead to bone marrow depressions and promote hematologic malignancies. Our objective was to explore indications for and results of bone marrow examinations in a large cohort. METHODS: Between 1990 and 2004 146 bone marrow examinations in 3638 patients were performed due to abnormal laboratory results. Medical history, results of bone marrow examination (morphology, histology) and cytogenetic data were investigated retrospectively. RESULTS:Patients' (67.8% female) mean age at bone marrow examination was 53.5 years (SD 15.5), median disease duration 2.9 years. Indications for bone marrow examination were changes in peripheral blood counts in 81.7%. In 52 patients (35.6%) clinically relevant, partially neoplastic bone marrow changes (5 non-Hodgkin lymphoma, 9 myelodysplastic syndromes (MDS)/acute myeloid leukemia (AML) and 3 myeloproliferative neoplasias) were evident. Medication history showed intake of hydroxy-/chloroquine (13.5%), methotrexate (17.3%), cyclosporin (7.7%), sulfasalazine (7.7%), mycophenolatmofetil, gold, leflunomide (each 1.9%), azathioprine (aza, 25.0%) or cyclophosphamide (cyc, 7.7%) prior to bone marrow examination. 7 out of 9 patients, who developed MDS/AML had been treated with either azathioprine alone or additionally with cyclophosphamide (n = 3). CONCLUSION: One third of our patients showed relevant bone marrow changes that might be associated to therapy. The risk seems to be increased especially in patients with inflammatory rheumatic diseases who had received azathioprine alone or in combination with cyclophosphamide. Health care providers should bear in mind the risk of hematologic malignancies and monitor patients closely in this respect. Bone marrow examination should be performed in case of changes in peripheral blood counts; especially clinically relevant anemia, granulocytes < 2,500/microl, thrombocytes < 100,000/microl and relevant changes over time should lead to bone marrow examinations.
Authors: Eva Baecklund; Anastasia Iliadou; Johan Askling; Anders Ekbom; Carin Backlin; Fredrik Granath; Anca Irinel Catrina; Richard Rosenquist; Nils Feltelius; Christer Sundström; Lars Klareskog Journal: Arthritis Rheum Date: 2006-03
Authors: J Askling; C M Fored; E Baecklund; L Brandt; C Backlin; A Ekbom; C Sundström; L Bertilsson; L Cöster; P Geborek; L T Jacobsson; S Lindblad; J Lysholm; S Rantapää-Dahlqvist; T Saxne; L Klareskog; N Feltelius Journal: Ann Rheum Dis Date: 2005-04-20 Impact factor: 19.103
Authors: Eva Baecklund; Carin Backlin; Anastasia Iliadou; Fredrik Granath; Anders Ekbom; Rose-Marie Amini; Nils Feltelius; Gunilla Enblad; Christer Sundström; Lars Klareskog; Johan Askling; Richard Rosenquist Journal: Arthritis Rheum Date: 2006-12
Authors: Karin Hellgren; Anastasia Iliadou; Richard Rosenquist; Nils Feltelius; Carin Backlin; Gunilla Enblad; Johan Askling; Eva Baecklund Journal: Ann Rheum Dis Date: 2009-05-12 Impact factor: 19.103
Authors: Rachelle Buchbinder; Melissa Barber; Louise Heuzenroeder; Anita E Wluka; Graham Giles; Stephen Hall; Andrew Harkness; Daniel Lewis; Geoff Littlejohn; Marian H Miller; Peter F J Ryan; Damien Jolley Journal: Arthritis Rheum Date: 2008-06-15