Research Article
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Does Bone Marrow Evaluation Have a Contribution to Clinical Management in Patients Seventy Five Years and Older?

Year 2020, Volume: 46 Issue: 2, 195 - 201, 01.08.2020
https://doi.org/10.32708/uutfd.734858

Abstract

In clinical practice the role of bone marrow evaluation (BM) in the elderly, especially in patients over 75 years old who are referred as middle/advanced old, is not clear. In this study the aim was to assess the indications, results and the contribution of BM aspiration and biopsies to the clinical management and outcomes in patients over 75 years old. All ≥75 years old patients to whom BM evaluation was performed between January 2014 and December 2018 in our clinic were assessed retrospectively. The clinical properties, laboratory, peripheral blood smear and BM aspiration/biopsy results, the applied treatments and the survival outcomes were evaluated. The mean age of the 81 included patients was 80.4±4 (75-95). There was no procedure-related complication. Cytopenias were the most frequent indication. Anemia, leukopenia and thrombocytopenia were detected in 87.6%, 25.9% and 50.6% respectively. Myelodyspastic syndrome (MDS) was the most frequent diagnosis. Multiple myeloma, myeloproliferative diseases and non-Hodgkin lymphoma were the following diagnoses. Aspiration and biopsy showed high correlation. In general the median survival was 69 months in the treated patients and 35 months in non-treated patients. Two-years overall survival was 57% in the treated and 41.7% in non-treated patients. In conclusion in order to diagnose hematological and some non-hematological disorders confined to advanced age, BM evaluation may be performed safely in patients over 75 years old. The indications of BM evaluation is different than childhood and younger adulthood. Treatment of disorders that were diagnosed with this procedure provides a survival benefit. For this reason whenever indicated, in order to diagnose and improve the survival with appropriate treatment, BM evaluation may be offered to patients in this age group.

References

  • Türkiye istatistik kurumu, Temel istatistikler, http://www.tuik.gov.tr/UstMenu.do?metod=temelist, en son erişim 07/05/2020
  • Prabhakar M, Ershler WB, Longo DL. Bone marrow, thymus and blood: changes across the lifespan. Aging health. 2009;5:385‐93
  • Al-Gwaiz LA. Analysis of 3494 bone marrow examinations in areferral hospital: indications and interpretations. Saudi Med J.1997;18:144-7
  • Bashawri LA. Bone marrow examination: indications anddiagnostic value. Saudi Med J. 2002;23:191-6
  • World Health Organization. (2017). World report on Ageing and Health. http:// apps.who.int/iris/bitstream/10665/ 186463/ 1/9789240694811_eng.pdf (Erişim tarihi: 07.05.2018)
  • Kaur G, Basu S, Kaur P, Sood T. Metastatic bone marrow tumors: Study of nine cases and review of the literature. J Blood Disord Transfus 2011;2:110
  • Longo, DL. Immunology of aging. In: Paul, WE., editor. Fundamental Immunology. Vol. 5th edition. Williams and Wilkins; Philadelphia, Lippicott: 2003. p. 1043-1075.
  • Hakim FT, Gress RE. Immunosenescence: deficits in adaptive immunity in the elderly. Tissue Antigens 2007;70:179–89.
  • Linton PJ, Dorshkind K. Age-related changes in lymphocyte development and function. Nat Immunol 2004;5:133–9
  • Lichtman MA, Rowe JM. The relationship of patient age to the pathobiology of the clonal myeloid diseases. Semin Oncol 2004;31:185–97
  • Beghe C, Wilson A, Ershler WB. Prevalence and outcomes of anemia in geriatrics: a systematic review of the literature. Am J Med 2004;116(Suppl 7A):3S–10S
  • Guralnik JM, Eisenstaedt RS, Ferrucci L, Klein HG, Woodman RC. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood 2004;104:2263–8.
  • Hartsock RJ, Smith EB, Petty CS. Normal variations with aging of the amount of hematopoietic tissue in bone marrow from the anterior iliac crest. a study made from 177 cases of sudden death examined by necropsy. Am J Clin Pathol 1965;43:326–31.
  • Ricci C, Cova M, Kang YS, et al. Normal age-related patterns of cellular and fatty bone marrow distribution in the axial skeleton: MR imaging study. Radiology 1990;177:83–8
  • Justesen J, Stenderup K, Ebbesen EN, Mosekilde L, Steiniche T, Kassem M. Adipocyte tissue volüme in bone marrow is increased with aging and in patients with osteoporosis. Biogerontology 2001;2:165–71
  • MacKinney AA Jr. Effect of aging on the peripheral blood lymphocyte count. J Gerontol 1978;33: 213–6
  • Manion EM, Rosenthal NS. Bone marrow biopsies in patients 85 years or older. Am J Clin Pathol. 2008;130:832-5
  • Sulakshana MS, Ahmed SM, Raghupati AR. Bone marrow changes in elderly. IAIM, 2015;2:27-33
  • Gulati A, Mandal T, Kaushal V, Kaushik R, Thakur S. Bone marrow disease profile in geriatric patients: an institutional experience. Indian J Hematol Blood Transfus. 2018;34:540-3
  • Öztorun HS, Turgut T, Sürmeli DM, ve ark. Geriatri kliniğimizde yapılan kemik iliği biyopsi sonuçlarının çok yönlü değerlendirilmesi: tanı, prezentasyon ve mortalite. J Contemp Med, 2018;8:122-7
  • Aytan P, Kocer NE, Yeral M, et al. Non-hematologic malignancies metastasing to the bone marrow: a record-based descriptive study from a tertiary center. UHOD, 2020;30:238-45
  • French registry of acute leukemia and myelodysplastic syndromes. Age distribution and hemogram analysis of the 4496 cases recorded during 1982-1983 and classified according to FAB criteria. Groupe Francais de Morphologie Hematologique. Cancer. 1987;60:1385-94.
  • Türk Hematoloji Derneği, Multipl Myelom ulusal tanı ve tedavi kılavuzu, ISBN: 978-605-80353-4-8, Edition 1.03 - Mart 2020:1, Galenos Yayınevi, Istanbul, Türkiye
  • Thapa B, Rogers HJ. Cancer, Myeloproliferative Neoplasms. [Updated 2019 Nov 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK531464/
  • Roman E, Smith AG. Epidemiology of lymphomas. Histopathol 2011;58:4-14.
  • Vásárhelyi B, Debreczeni LA. Lab test findings in the elderly. EJIFCC. 2017;28:328-32
  • Blanc B, Finch CA, Hallberg L. Nutritional anaemias. Report of a WHO Scientific Group. WHO Tech Rep Ser 1968;405:1–40
  • Chaves PH, Xue QL, Guralnik JM, Ferrucci L, Volpato S, Fried LP. What constitutes normal hemoglobin concentration in community-dwelling disabled older women? J Am Geriatr Soc 2004;52:1811–6
  • Beutler E, Waalen J. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood. 2006;107:1747
  • Steensma DP, Tefferi A. Anemia in the elderly: how should we define it, when does it matter, and what can be done? Mayo Clin Proc. 2007;82:958-66.
  • Eisenstaedt R, Penninx BW, Woodman RC. Anemia in the elderly: current understanding and emerging concepts. Blood Rev. 2006;20:213-6
  • Balducci L. Epidemiology of anemia in the elderly: information on diagnostic evaluation. J Am Geriatr Soc. 2003;51(3suppl):S2-S9
  • Block M. Bone marrow examination: aspiration or core biopsy, smear or sections, hematoxylin-eosin or Romanowsky stain—which combination? Arch Pathol Lab Med 1976;100:454–6
  • Bain BJ. Bone marrow biopsy morbidity and mortality. Br J Haematol. 2003;121:949-51.

Yetmiş Beş Yaş ve Üstü Hastalarda Kemik İliği Değerlendirmesinin Klinik Yaklaşıma Katkısı Var mıdır?

Year 2020, Volume: 46 Issue: 2, 195 - 201, 01.08.2020
https://doi.org/10.32708/uutfd.734858

Abstract

Yaşlı hastalarda, özellikle de orta/ileri yaşlılık olarak tanımlanan ≥75 yaş grubunda kemik iliği değerlendirmenin klinik uygulamalardaki yeri net değildir. Bu çalışmada ≥75 yaşındaki hastalarda yapılan kemik iliği biyopsi ve aspirasyon endikasyonlarının, sonuçlarının ve yapılan kemik iliği incelemesinin klinik yaklaşıma ve sonuçlara katkısının değerlendirilmesi amaçlanmıştır. Ocak 2014- Aralık 2018 yılları arasında kliniğimizde kemik iliği incelemesi yapılan tüm ≥75 yaş hastalar retrospektif olarak değerlendirildi. Hastaların klinik özellikleri ve laboratuvar kan değerleri, periferik yayma, kemik iliği aspirasyon ve biyopsi sonuçları, aldıkları tedaviler ve sağ kalımları değerlendirildi. Çalışmaya dâhil edilen 81 hastanın ortalama yaşı 80,4±4 yıldı (75-95). İşleme bağlı komplikasyon görülmedi. Sitopeniler en sık endikasyondu. Anemi %87,6 oranında görülürken, lökopeni %25,9 ve trombositopeni %50,6 oranında görülmekteydi. En sık konulan tanı miyelodisplastik sendromdu (MDS). Yine multipl miyelom, miyeloproliferatif hastalıklar ve non-Hodgkin lenfoma MDS’yi takip ediyordu. Aspirasyon ve biyopsi yüksek oranda uyum göstermekteydiler. Genel olarak tedavi alan hastalarda ortanca sağ kalım süresi 69 ayken, almayan grupta 35 aydı. Yine 2 yıllık genel sağ kalım tedavi alan hastalarda %57 iken, almayan hastalarda %41,7 idi. Sonuç olarak ≥75 yaş hastalarda, ileri yaşa özgü hematolojik ve bazı non-hematolojik hastalıkların tanısının konulması için kemik iliği incelemesi güvenle yapılabilir. Kemik iliği incelemesinin endikasyonları çocuk ve genç erişkinlerinkinden farklıdır. Bu incelemeyle tanısı konulan hastalıklarda uygulanan tedaviler ile sağ kalım artmaktadır. Bu nedenle endikasyon varlığında, tanının konulması ve uygun tedavinin başlanması yolu ile sağ kalımı arttırmak için kemik iliği incelemesi bu yaş grubuna önerilmelidir.

References

  • Türkiye istatistik kurumu, Temel istatistikler, http://www.tuik.gov.tr/UstMenu.do?metod=temelist, en son erişim 07/05/2020
  • Prabhakar M, Ershler WB, Longo DL. Bone marrow, thymus and blood: changes across the lifespan. Aging health. 2009;5:385‐93
  • Al-Gwaiz LA. Analysis of 3494 bone marrow examinations in areferral hospital: indications and interpretations. Saudi Med J.1997;18:144-7
  • Bashawri LA. Bone marrow examination: indications anddiagnostic value. Saudi Med J. 2002;23:191-6
  • World Health Organization. (2017). World report on Ageing and Health. http:// apps.who.int/iris/bitstream/10665/ 186463/ 1/9789240694811_eng.pdf (Erişim tarihi: 07.05.2018)
  • Kaur G, Basu S, Kaur P, Sood T. Metastatic bone marrow tumors: Study of nine cases and review of the literature. J Blood Disord Transfus 2011;2:110
  • Longo, DL. Immunology of aging. In: Paul, WE., editor. Fundamental Immunology. Vol. 5th edition. Williams and Wilkins; Philadelphia, Lippicott: 2003. p. 1043-1075.
  • Hakim FT, Gress RE. Immunosenescence: deficits in adaptive immunity in the elderly. Tissue Antigens 2007;70:179–89.
  • Linton PJ, Dorshkind K. Age-related changes in lymphocyte development and function. Nat Immunol 2004;5:133–9
  • Lichtman MA, Rowe JM. The relationship of patient age to the pathobiology of the clonal myeloid diseases. Semin Oncol 2004;31:185–97
  • Beghe C, Wilson A, Ershler WB. Prevalence and outcomes of anemia in geriatrics: a systematic review of the literature. Am J Med 2004;116(Suppl 7A):3S–10S
  • Guralnik JM, Eisenstaedt RS, Ferrucci L, Klein HG, Woodman RC. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood 2004;104:2263–8.
  • Hartsock RJ, Smith EB, Petty CS. Normal variations with aging of the amount of hematopoietic tissue in bone marrow from the anterior iliac crest. a study made from 177 cases of sudden death examined by necropsy. Am J Clin Pathol 1965;43:326–31.
  • Ricci C, Cova M, Kang YS, et al. Normal age-related patterns of cellular and fatty bone marrow distribution in the axial skeleton: MR imaging study. Radiology 1990;177:83–8
  • Justesen J, Stenderup K, Ebbesen EN, Mosekilde L, Steiniche T, Kassem M. Adipocyte tissue volüme in bone marrow is increased with aging and in patients with osteoporosis. Biogerontology 2001;2:165–71
  • MacKinney AA Jr. Effect of aging on the peripheral blood lymphocyte count. J Gerontol 1978;33: 213–6
  • Manion EM, Rosenthal NS. Bone marrow biopsies in patients 85 years or older. Am J Clin Pathol. 2008;130:832-5
  • Sulakshana MS, Ahmed SM, Raghupati AR. Bone marrow changes in elderly. IAIM, 2015;2:27-33
  • Gulati A, Mandal T, Kaushal V, Kaushik R, Thakur S. Bone marrow disease profile in geriatric patients: an institutional experience. Indian J Hematol Blood Transfus. 2018;34:540-3
  • Öztorun HS, Turgut T, Sürmeli DM, ve ark. Geriatri kliniğimizde yapılan kemik iliği biyopsi sonuçlarının çok yönlü değerlendirilmesi: tanı, prezentasyon ve mortalite. J Contemp Med, 2018;8:122-7
  • Aytan P, Kocer NE, Yeral M, et al. Non-hematologic malignancies metastasing to the bone marrow: a record-based descriptive study from a tertiary center. UHOD, 2020;30:238-45
  • French registry of acute leukemia and myelodysplastic syndromes. Age distribution and hemogram analysis of the 4496 cases recorded during 1982-1983 and classified according to FAB criteria. Groupe Francais de Morphologie Hematologique. Cancer. 1987;60:1385-94.
  • Türk Hematoloji Derneği, Multipl Myelom ulusal tanı ve tedavi kılavuzu, ISBN: 978-605-80353-4-8, Edition 1.03 - Mart 2020:1, Galenos Yayınevi, Istanbul, Türkiye
  • Thapa B, Rogers HJ. Cancer, Myeloproliferative Neoplasms. [Updated 2019 Nov 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK531464/
  • Roman E, Smith AG. Epidemiology of lymphomas. Histopathol 2011;58:4-14.
  • Vásárhelyi B, Debreczeni LA. Lab test findings in the elderly. EJIFCC. 2017;28:328-32
  • Blanc B, Finch CA, Hallberg L. Nutritional anaemias. Report of a WHO Scientific Group. WHO Tech Rep Ser 1968;405:1–40
  • Chaves PH, Xue QL, Guralnik JM, Ferrucci L, Volpato S, Fried LP. What constitutes normal hemoglobin concentration in community-dwelling disabled older women? J Am Geriatr Soc 2004;52:1811–6
  • Beutler E, Waalen J. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood. 2006;107:1747
  • Steensma DP, Tefferi A. Anemia in the elderly: how should we define it, when does it matter, and what can be done? Mayo Clin Proc. 2007;82:958-66.
  • Eisenstaedt R, Penninx BW, Woodman RC. Anemia in the elderly: current understanding and emerging concepts. Blood Rev. 2006;20:213-6
  • Balducci L. Epidemiology of anemia in the elderly: information on diagnostic evaluation. J Am Geriatr Soc. 2003;51(3suppl):S2-S9
  • Block M. Bone marrow examination: aspiration or core biopsy, smear or sections, hematoxylin-eosin or Romanowsky stain—which combination? Arch Pathol Lab Med 1976;100:454–6
  • Bain BJ. Bone marrow biopsy morbidity and mortality. Br J Haematol. 2003;121:949-51.
There are 34 citations in total.

Details

Primary Language Turkish
Subjects Haematology
Journal Section Research Article
Authors

Pelin Aytan 0000-0002-4213-1565

Mahmut Yeral 0000-0002-9580-628X

Emrah Koçer 0000-0003-3636-8109

Can Boğa 0000-0002-9680-1958

Publication Date August 1, 2020
Acceptance Date August 14, 2020
Published in Issue Year 2020 Volume: 46 Issue: 2

Cite

APA Aytan, P., Yeral, M., Koçer, E., Boğa, C. (2020). Yetmiş Beş Yaş ve Üstü Hastalarda Kemik İliği Değerlendirmesinin Klinik Yaklaşıma Katkısı Var mıdır?. Uludağ Üniversitesi Tıp Fakültesi Dergisi, 46(2), 195-201. https://doi.org/10.32708/uutfd.734858
AMA Aytan P, Yeral M, Koçer E, Boğa C. Yetmiş Beş Yaş ve Üstü Hastalarda Kemik İliği Değerlendirmesinin Klinik Yaklaşıma Katkısı Var mıdır?. Uludağ Tıp Derg. August 2020;46(2):195-201. doi:10.32708/uutfd.734858
Chicago Aytan, Pelin, Mahmut Yeral, Emrah Koçer, and Can Boğa. “Yetmiş Beş Yaş Ve Üstü Hastalarda Kemik İliği Değerlendirmesinin Klinik Yaklaşıma Katkısı Var mıdır?”. Uludağ Üniversitesi Tıp Fakültesi Dergisi 46, no. 2 (August 2020): 195-201. https://doi.org/10.32708/uutfd.734858.
EndNote Aytan P, Yeral M, Koçer E, Boğa C (August 1, 2020) Yetmiş Beş Yaş ve Üstü Hastalarda Kemik İliği Değerlendirmesinin Klinik Yaklaşıma Katkısı Var mıdır?. Uludağ Üniversitesi Tıp Fakültesi Dergisi 46 2 195–201.
IEEE P. Aytan, M. Yeral, E. Koçer, and C. Boğa, “Yetmiş Beş Yaş ve Üstü Hastalarda Kemik İliği Değerlendirmesinin Klinik Yaklaşıma Katkısı Var mıdır?”, Uludağ Tıp Derg, vol. 46, no. 2, pp. 195–201, 2020, doi: 10.32708/uutfd.734858.
ISNAD Aytan, Pelin et al. “Yetmiş Beş Yaş Ve Üstü Hastalarda Kemik İliği Değerlendirmesinin Klinik Yaklaşıma Katkısı Var mıdır?”. Uludağ Üniversitesi Tıp Fakültesi Dergisi 46/2 (August 2020), 195-201. https://doi.org/10.32708/uutfd.734858.
JAMA Aytan P, Yeral M, Koçer E, Boğa C. Yetmiş Beş Yaş ve Üstü Hastalarda Kemik İliği Değerlendirmesinin Klinik Yaklaşıma Katkısı Var mıdır?. Uludağ Tıp Derg. 2020;46:195–201.
MLA Aytan, Pelin et al. “Yetmiş Beş Yaş Ve Üstü Hastalarda Kemik İliği Değerlendirmesinin Klinik Yaklaşıma Katkısı Var mıdır?”. Uludağ Üniversitesi Tıp Fakültesi Dergisi, vol. 46, no. 2, 2020, pp. 195-01, doi:10.32708/uutfd.734858.
Vancouver Aytan P, Yeral M, Koçer E, Boğa C. Yetmiş Beş Yaş ve Üstü Hastalarda Kemik İliği Değerlendirmesinin Klinik Yaklaşıma Katkısı Var mıdır?. Uludağ Tıp Derg. 2020;46(2):195-201.

ISSN: 1300-414X, e-ISSN: 2645-9027

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