Targeted Pathologic Evaluation of Bone Marrow Donors Identifies Previously Undiagnosed Marrow Abnormalities
Matthew P Tilson, Richard J Jones, Christopher D Gocke, Milena Vuica-Ross, Kathleen H Burns, Michael J Borowitz, Amy S Duffield. Johns Hopkins Medical Institutions, Baltimore, MD
Background: Potential bone marrow donors are screened to ensure the safety of both potential donor and recipient. At our institution, the screen includes bone marrow evaluation in potential donors with abnormal peripheral blood cell counts, a personal history of malignancy, or >60 years of age.
Design: 121 potential donors were evaluated with a bone marrow aspirate and biopsy between the years of 2001-2011, encompassing approximately 10% of all donors. Flow cytometry (FC; 119) and cytogenetic studies (CG; 118) were also performed in most cases.
Results: The average age of the screened potential donors was 55.85 years (17-81) and included 68 men and 63 women. Marrow evaluation was initiated due to age >60 years old(33); anemia(22) or other cytopenias(27); elevated counts with(10) or without(19) concurrent cytopenias; history of malignancy(4); abnormal peripheral blood differential(3); prior graft failure(1); history of treatment with methotrexate(1); and body habitus(1). Nine (7.4%) of the potential donors were rejected due to abnormalities found upon pathologic examination of the marrow. Reasons for bone marrow evaluation on these rejected donors included anemia(4); anemia and leukopenia(1); history of cancer(2); and age >60 years old(2). Atypical findings in the 9 patients were detected by bone marrow examination(5), flow cytometric studies(1), both biopsy and flow cytometry(1), and cytogenetic studies(2). Abnormalities identified on bone marrow examination included plasma cell dyscrasia(2), low grade myelodysplastic syndrome(1), hypercellular marrow of unclear etiology(1), and hypocellular marrow of unclear etiology(1). FC revealed a small monoclonal population of plasma cells in a patient who was also diagnosed as having a plasma cell dyscrasia on biopsy, and FC also demonstrated a monoclonal B lymphocytosis in another patient with a normal biopsy and CG studies. Two donors had normal morphologic and flow cytometric findings, but were found to have CG abnormalities; a donor with del(20q) had a history of chemotherapy for testicular cancer, and a donor with del(5q) was screened because she was over 60 years old.
Conclusions: Evaluation of potential marrow donors by bone marrow biopsy, flow cytometric and cytogenetic analysis is warranted, as each modality independently identified abnormalities. Routine screening of potential donors >60 years of age or with a history of radio- or chemotherapy identified a small but significant number of patients with previously undiagnosed marrow abnormalities.
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 246, Wednesday Afternoon