Tadmor et al evaluated patients with chronic lymphocytic leukemia based on the extent of fibrosis seen in the bone marrow biopsy at the time of diagnosis. The authors are from multiple hospitals in Israel.


Patient selection: CLL


Bone marrow fibrosis was graded as mild/early (Grade 0 or 1) and advanced/diffuse/dense (Grade 2 or 3).

Fibrosis on a Reticulin Stain


scattered linear reticulin fibers without intersections


loose network of reticulin fibers


diffuse reticulin fibers with intersections


dense reticulin fibrosis with extensive intersections



Prognostic factors from multivariate analysis:

(1) Binet stage C

(2) advanced fibrosis


A patient with advanced bone marrow fibrosis tended to have:

(1) thrombocytopenia (platelet count < 100,000 per µL)

(2) anemia

(3) elevated concentration of beta-2 microglobulin (> 1.5 times the upper limit of normal)

(4) presence of the 11q deletion and possibly 17p deletion


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