Gelatinous marrow transformation (GMT) is an unusual pathological manifestation of progressive malignant diseases and severe malnutrition states. GMT has been associated with various accelerated hematological malignancies, but has never been described in patients with chronic myelogenous leukemia (CML) treated with imatinib mesylate (IM), a novel tyrosine kinase inhibitor. Herein we report 2 patients with stable chronic phase CML who developed GMT during the course of treatment with IM. A comprehensive review of the relevant published data, several possible mechanisms and therapeutic alternatives are suggested.

1.
Tavassoli M, Eastlund DT, Yam LT, Neiman RS, Finkel H: Gelatinous transformation of bone marrow in prolonged self-induced starvation. Scand J Haematol 1976;16:311–319.
2.
Bohm J: Gelatinous transformation of the bone marrow: the spectrum of underlying diseases. Am J Surg Pathol 2000;24:56–65.
3.
Seaman JP, Kjeldsberg CR, Linker A: Gelatinous transformation of the bone marrow. Hum Pathol 1978;9:685–692.
4.
Clarke BE, Brown DJ, Xipell JM: Gelatinous transformation of the bone marrow. Pathology 1983;15:85–88.
5.
Janssens AM, Offner FC, Van Hove WZ: Bone marrow necrosis. Cancer 2000;88:1769–1780.
6.
Arranz R, Gil-Fernandez JJ, Acevedo A, Tomas JF, Alegre A, Fernandez-Ranada JM: Gelatinous degeneration presenting as a preleukaemic syndrome. J Clin Pathol 1996;49:512–514.
7.
Bohm J, Schmitt-Graff A: Gelatinous bone marrow transformation in a case of idiopathic myelofibrosis: a morphological paradox. Pathol Res Pract 2000;196:775–779.
8.
Sen R, Singh S, Singh H, Gupta A, Sen J: Clinical profile in gelatinous bone marrow transformation. J Assoc Physicians India 2003;51:585–588.
9.
Feng CS: A variant of gelatinous transformation of marrow in leukemic patients post-chemotherapy. Pathology 1993;25:294–296.
10.
Feng CS: Gelatinous transformation of marrow in a case of acute myelogenous leukemia post-chemotherapy. Am J Hematol 1991;38:220–222.
11.
Mathew M, Mathews I, Manohar C, Rao S: Gelatinous transformation of bone marrow following chemotherapy for myeloma. Indian J Pathol Microbiol 2001;44:53–54.
12.
Thiele J, Kvasnicka HM, Schmitt-Graeff A, Diehl V: Bone marrow histopathology following cytoreductive therapy in chronic idiopathic myelofibrosis. Histopathology 2003;43:470–479.
13.
Hurwitz N: Bone marrow trephine biopsy changes following chemotherapy and/or bone marrow transplantation. Curr Diagnostic Pathol 1997;4:196–202.
14.
Lugli A, Ebnoether M, Cogliatti SB, Gratwohl A, Passweg J, Hess U, Korte W, Hawle H, Tinguely M, Borisch B, Mach-Pascual S, Von Juergensonn S, Tichelli A, Dirnhofer S: Proposal of a morphologic bone marrow response score for imatinib mesylate treatment in chronic myelogenous leukemia. Hum Pathol 2005;36:91–100.
15.
Lokeshwar N, Kumar L, Kumari M: Severe bone marrow aplasia following imatinib mesylate in a patient with chronic myelogenous leukemia. Leuk Lymphoma 2005;46:781–784.
16.
Srinivas U, Pillai LS, Kumar R, Pati HP, Saxena R: Bone marrow aplasia – a rare complication of imatinib therapy in CML patients. Am J Hematol 2007;82:314–316.
17.
Matsue K, Takeuchi M, Koseki M, Uryu H: Bone marrow necrosis associated with the use of imatinib mesylate in a patient with Philadelphia chromosome-positive acute lymphoblastic leukemia. Ann Hematol 2006;85:542–544.
18.
Campiotti L, Codari R, Appio L, Ultori C, Solbiati F, Maria GA, Venco A: Bone marrow necrosis related to imatinib mesylate therapy for cml bilineal blast crisis. Leuk Res 2007;31:1768–1770.
19.
Tamura T, Tasaka T, Fujimoto M, Matsuhashi Y, Fukumot T, Mano S, Kuwajima M, Nagai M: Massive bone marrow necrosis in a patient with chronic myelocytic leukemia following imatinib mesylate therapy. Haematologica 2004;89:ECR32.
20.
Daniels CE, Wilkes MC, Edens M, Kottom TJ, Murphy SJ, Limper AH, Leof EB: Imatinib mesylate inhibits the profibrogenic activity of TGF-beta and prevents bleomycin-mediated lung fibrosis. J Clin Invest 2004;114:1308–1316.
21.
Distler JH, Jungel A, Huber LC, Schulze-Horsel U, Zwerina J, Gay RE, Michel BA, Hauser T, Schett G, Gay S, Distler O: Imatinib mesylate reduces production of extracellular matrix and prevents development of experimental dermal fibrosis. Arthritis Rheum 2007;56:311–322.
22.
Fierro F, Illmer T, Jing D, Schleyer E, Ehninger G, Boxberger S, Bornhauser M: Inhibition of platelet-derived growth factor receptorbeta by imatinib mesylate suppresses proliferation and alters differentiation of human mesenchymal stem cells in vitro. Cell Prolif 2007;40:355–366.
23.
Corre J, Planat-Benard V, Corberand JX, Penicaud L, Casteilla L, Laharrague P: Human bone marrow adipocytes support complete myeloid and lymphoid differentiation from human CD34 cells. Br J Haematol 2004;127:344–347.
24.
Kvasnicka HM, Thiele J, Staib P, Schmitt-Graeff A, Griesshammer M, Klose J, Engels K, Kriener S: Reversal of bone marrow angiogenesis in chronic myeloid leukemia following imatinib mesylate (STI571) therapy. Blood 2004;103:3549–3551.
25.
Ebos JM, Tran J, Master Z, Dumont D, Melo JV, Buchdunger E, Kerbel RS: Imatinib mesylate (STI-571) reduces Bcr-Abl-mediated vascular endothelial growth factor secretion in chronic myelogenous leukemia. Mol Cancer Res 2002;1:89–95.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.