Myelophtisis

Old aspects, new concepts

Abstract

Background: myelophthisis is a form of bone marrow failure due to replacement of hematopoietic tissue by abnormal tissue, most commonly metastatic carcinomas.

Materials and methods: this retrospective study included 89 patients (pts) with solid tumors and myelophtisis that had been treated from 1991 to 2006 in a single reference center in Bogotá. We made a detailed analysis of pts characteristics and outcomes.

Results: mean age was 47.5+17.2 years, there was homogeneous gender distribution (F46/M43) and 62% patients had a PS =60%. Twenty-seven patients (30%) had breast cancer, pathology followed by primary unknown tumours (21%), rabdomiosarcoma (10%), prostate adenocarcinoma (10%), gastric carcinoma (7%) and others (22%). At the time when myelophtisis was documented 72% and 50% of patients had osseous and visceral metastasis respectively; 81 patients presented anaemia (Hb 9.8 + 1.2 gr/dl), mean platelet count was 174,000 and mean leukocyte count was 24,283 + 5,447. Forty-three patients received chemotherapy following the diagnosis of medullar infiltration, and normal leukocyte count was being seen in 40% of them after such treatment. Nine episodes of febrile neutropenia were found; median overall survival (OS) following the diagnosis of neoplasia and myelophtisis were 13.8 months and 2.2 months respectively. The factors related to lower survival rate were the presence of Hb =8.5 gr/dl (HR: 0,54, CI95% 0,32-0,95; p = 0.04), >3 metastasis sites (HR: 0,67, CI95% 0,45-0,92; p = 0.03), visceral disease (HR: 0,72, CI95% 0,66-0,89; p = 0.04) and febrile neutropenia caused by chemotherapy (HR: 0,52, CI95% 0,37-0,60; p = 0.02).

Conclusions: myelophtisis is a serious condition modifying the OS of patients having solid tumours. Treatment for this subgroup should be selected bearing in mind its potential haematological toxicity