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Bone marrow fibrosis associated with long-term imatinib therapy: resolution after switching to a second-generation TKI

Naranie Shanmuganathan, Susan Branford, Timothy P. Hughes and Devendra Hiwase

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Figures

  • Figure 1.

    Imatinib-induced bone marrow fibrosis in case 1. (A) Bone marrow biopsy at diagnosis. Hematoxylin and eosin staining of the bone marrow at diagnosis. (B) Bone marrow biopsy after 37 months of imatinib therapy. Hematoxylin and eosin staining at identification of bone marrow fibrosis. (C) Bone marrow biopsy after 13 months of nilotinib therapy. Hematoxylin and eosin staining following imatinib cessation. (D) Bone marrow biopsy at diagnosis. Silver stain of the bone marrow at diagnosis. (E) Bone marrow biopsy after 37 months of imatinib therapy. Silver stain at identification of bone marrow fibrosis. (F) Bone marrow biopsy after 13 months of nilotinib therapy. Silver stain following imatinib cessation. (A-F) Images taken with an Olympus BX51 microscope at 10× magnification. (G) Graph demonstrating treatment timeline and relationship between hemoglobin and BCR-ABL1. Green arrow, bone marrow biopsy with corresponding image indicated. BD, twice daily; IM, imatinib; NIL, nilotinib; OD, once daily.

  • Figure 2.

    Imatinib-induced bone marrow fibrosis in case 2. (A) Bone marrow biopsy 24 months after diagnosis. Hematoxylin and eosin staining of the bone marrow 24 months after diagnosis. (B) Bone marrow biopsy after 60 months of imatinib therapy. Hematoxylin and eosin staining at identification of bone marrow fibrosis. (C) Bone marrow biopsy after 7 months of dasatinib therapy. Hematoxylin and eosin staining following imatinib cessation. (D) Bone marrow biopsy 24 months after diagnosis. Silver stain of the bone marrow 24 months after diagnosis. (E) Bone marrow biopsy after 60 months of imatinib therapy. Silver stain at identification of bone marrow fibrosis. (F) Bone marrow biopsy after 7 months of dasatinib therapy. Silver stain following imatinib cessation. Images taken with an Olympus BX51 microscope at 10× magnification (A-D,F) and 20× magnification (E). (G) Graph demonstrating treatment timeline and relationship between hemoglobin and BCR-ABL1. Green arrow, bone marrow biopsy with corresponding image indicated. DAS, dasatinib.