Naeim F, Champlin R, Nimer S
Department of Pathology, UCLA School of Medicine 90024.
Hematol Pathol. 1990;4(2):79-85.
The morphologic changes in the bone marrow of eight patients with refractory aplastic anemia who received 4 or more weeks of granulocyte macrophage-colony-stimulating factor (GM-CSF) are described. All eight patients demonstrated a continuous rise in the absolute number of neutrophils, eosinophils, and monocytes over the first four weeks of therapy. Bone marrow examination revealed a progressive increase in bone marrow cellularity in all patients except one. An increase in myeloid: erythroid ratio was seen with progressive maturation of granulocytic cells. Neutrophilic and eosinophilic myelocytes were the most prominent cells. The percentage of myeloblasts and promyelocytes did not increase significantly, and the proportions of postmitotic granulocytic cells did not change either. No significant morphologic changes were noted in the basophilic, erythroid, and megakaryocytic series. The most prominent topographic observation in the bone marrow during GM-CSF therapy was the frequent clustering of myeloid cells close to the bone trabeculae. The periosteal localization of myeloid precursors may reflect a higher concentration of stem cells and/or stromal cells in the bone marrow adjacent to the bone trabeculae or a higher concentration of growth factors. Careful morphologic examination of bone marrow in CSF clinical trials will provide useful information regarding the in vivo effects of these growth factors, and will aid in the development of a rational approach to combining them for therapy.
本文描述了8例接受粒细胞巨噬细胞集落刺激因子（GM-CSF）治疗4周或更长时间的难治性再生障碍性贫血患者骨髓的形态学变化。所有8例患者在治疗的前四周中性粒细胞、嗜酸性粒细胞和单核细胞的绝对数量持续上升。骨髓检查显示，除1例患者外，所有患者的骨髓细胞增多症均呈进行性增加。随着粒细胞的逐渐成熟，髓系与红系比例增加。嗜中性和嗜酸性髓细胞是最突出的细胞。原粒细胞和早幼粒细胞的百分比没有显著增加，有丝分裂后粒细胞的比例也没有变化。嗜碱性粒细胞系、红系和巨核细胞系未观察到明显的形态学变化。GM-CSF治疗期间骨髓最显著的地形学观察结果是髓系细胞频繁聚集在骨小梁附近。髓系前体细胞的骨膜定位可能反映了骨小梁附近骨髓中干细胞和/或基质细胞的浓度较高，或者生长因子的浓度较高。在CSF临床试验中对骨髓进行仔细的形态学检查将为这些生长因子的体内效应提供有用信息，并有助于制定合理的联合治疗方法。
