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The Latest in Hematology

How important is it to know whether cancer has invaded the bone marrow? Is it better to check, just to be sure, or to leave well enough alone? In this issue of The Differential: Hematology, we include a study that asks whether bone marrow biopsies in patients with follicular lymphoma, treated on U.S. Cooperative Group studies, really helped change prognosis of those patients. It turns out that biopsies were irrelevant to response assessment in 99% of patients, and among those who achieved a complete response on imaging, survival was no different among those with a bone marrow biopsy negative for lymphoma, and among those in whom biopsies were never performed. In this case, leaving well enough alone could save patients from an unnecessary and uncomfortable procedure.

Relevance of Bone Marrow Biopsies for Response Assessment in U.S. NCI National Clinical Trials Network Follicular Lymphoma Clinical Trials

Rutherford et al. aimed to identify if bone marrow biopsies (BMB) add value or predict outcomes for patients with follicular lymphoma. “Only 5/580 (0.9%) had positive baseline BMB, CR on imaging, and subsequent positive BMB (P < .0001). Therefore, BMB were irrelevant to response in 99% of subjects.” The team concluded that little value was added from BMB and recommended removing BMB as a follicular lymphoma clinical trial requirement.

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International Consensus Classification of Myeloid Neoplasms and Acute Leukemia: Integrating Morphological, Clinical, and Genomic Data

Considering recent advances and expanded understanding of hematologic malignancies since the 2016 classification of myeloid neoplasms and acute leukemias, a group of experts developed an International Consensus Classification (ICC) to introduce new entities and refine criteria for existing diagnostic categories. The ICC aims to facilitate the “diagnosis and prognostication of these neoplasms, improving treatment of affected patients, and allowing the design of innovative clinical trials.”

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TET2-Mutant Clonal Hematopoiesis and Risk of Gout

Clonal hematopoiesis of indeterminate potential (CHIP) is associated with elevated IL-1B, which is also associated with gout. Because of this, Agrawal et al. studied CHIP as a risk factor for gout. Through murine models of gout pathogenesis, the team confirmed that “TET2-mutant CHIP is associated with an increased risk of gout in humans”.

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