Megakaryocytic Clustering In Chronic Myeloid Leukemia: Can It Be A Predictor Of Clinical Outcome?

Objective: To compare clinical outcome in patients of chronic myeloid leukemia (CML) with and without megakaryocytic clustering.Study Design: Cross-sectional comparative study.Place and Duration of Study: Pathology Department and CML Clinic Oncology Department, King Edward Medical University from March 2018 to March 2019.Methodology: Ninety-four patients diagnosed with chronic phase of CML were included. Complete record of complete blood count, splenomegaly, findings of bone marrow aspirate and trephine biopsy was noted. Bone marrow trephine biopsy was reviewed for megakaryocytic clustering. Sokal scoring was done; and follow-up data for clinical outcome, i.e complete hematological response (CHR) at 3 months and major molecular response (MMR) at 6 months and 1 year (as per Institute's protocol) was obtained. All the data were analysed using SPSS version 25.Results: Megakaryocytic clustering was present in 57 (60.6%) patients and absent in 37 (39.4%). In patients with megakaryocytic clustering, CHR was absent in 12 (21.1%), MMR at 6 months was absent in 21 (36.8%) and MMR at 1 year was absent in 25 (43.9%) patients. In patients without megakaryocytic clustering, absent CHR, MMR at 6 months and MMR at 1 year were seen in 1 (2.7%), 2 (5.4%) and 2 (5.4%x), respectively. The correlation of megakaryocytic clustering and high sokal score was found to be statistically significant with a p-value <0.001.Conclusion: Patients with megakaryocytic clustering have poor clinical outcome as indicated by their sokal score, absent CHR, MMR at 6 months and 1 year.