*Pankaj Bahadur Nepali and Bhawani Manandhar


Introduction: The incidence acute lymphoblastic leukemia (ALL) has been increasing over the years. Chemotherapeutic agents used in the treatment of acute lymphoblastic leukemia (ALL) cause damage to the hematopoietic environment of the bone marrow initially, followed by stages of hematopoietic recovery. The study of post chemotherapy bone marrow in acute lymphoblastic leukemia (ALL) is essential to analyse the response to chemotherapy and also to study the effects of chemotherapeutic drugs on the bone marrow micro environment. Aims: 1) To study the changes in the marrow due to chemotherapeutic agents in ALL patients. 2) To study the response of leukemia to these drugs. 3) To study and compare bone marrow findings in the post induction phase and maintenance phase. Materials and methods: Total 50 cases of ALL in the post induction phase were enrolled for the study, out of these 31 cases were followed up in the maintenance phase. Bone marrow aspirate and biopsy slides were studied for these cases. Results: In the post induction phase bone marrow aspirates were predominantly hypocellular (46%) with normal to increased erythroid regeneration (74%) but decreased myelopoiesis and megakaryopoiesis. The erythroid maturation was mainly in the form of normoblastic(84%) or normoblastic with megaloblastoid changes (40%). Dyspoiesis was present in all three lineages (Erythroid series -46%, Myeloid series - 28%, Megakaryocytes- 28%). In the maintenance phase bone marrow was normocellular or hypercellular (67.8%) with normal to increased erythropoiesis (80.7%) and predominantly normoblastic maturation (83.9%). Regeneration of myeloid series (61.3%) and megakaryocytes (96.7%) was also improved than in post induction phase. In the maintenance phase erythroid and myeloid dyspoiesis were decreased whereas megakaryocytic dyspoiesis was increased than in post induction phase. Conclusion: Hence the study shows that though the bone marrow is hypocellular in the post induction phase, the cellularity improves during the maintenance phase. In the post induction phase erythroid regeneration appear first followed by myeloid and megakaryocytic regeneration.

Keywords: Post chemotherapy, Bone marrow, ALL.

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