Histological study of the bone marrow in chronic granulocytic leukaemia in blast transformation. I. Serial observations before and after autografting

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Abstract
Patients (16) with chronic granulocytic leukemia (CGL) in blast cell transformation (BT) were studied by means of serial bone marrow trephine biopsies (BMB). The BMB were performed during the following stages of the disease: 1 and diagnosis of BT, 2 following ablative therapy and 3 during hematological recovery following autografting. In 10 of the 16 patients, BT was recognized by the presence of a distinctive infiltration with blast cells with a single large hyperchromatic nucleolus. In 4 of the 16 patients, the diagnosis of BT could only be made by BMB since simultaneous marrow aspiration yielded a dry tap or no marrow fragments; in 2 of the 4 patients the BT was focal in the BMB specimen. Following ablative therapy and during hematological regeneration after autografting, BM aspirates were unsatisfactory in most cases and they were inadequate to assess cellularity or the presence of residual blasts. In contrast, sections of BMB showed clearly whether a decrease in cellularity took place or, in some, residual blasts were still present. BMB samples obtained 2 wk after autografting showed hemopoietic regeneration consisting of discrete foci of erythroid, granulocytic or megakaryocytic precursor cells. BMB is apparently essential for diagnosing CGL in BT, for monitoring the progress of these patients after therapy and in assessing the hemopoietic regeneration following autografting.