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Effect of Granulocytopenia, Marrow Suppressive Drugs, and Infection on Marrow Reticuloendothelial Patterns

St. Louis Veterans Administration Hospital and St. Louis University School of Medicine, St. Louis, Missouri

Correspondence: For reprints contact: Robert E. Henry (172-JC), St. Louis VA Hospital, St. Louis, Mo. 63125.

ABSTRACT

RE marrow extension beyond the proximal one-third of the femur and humerus was observed in 19 of 38 studies performed on 26 patients with Hodgkin's disease or lymphoma. All of the patients demonstrating RE marrow extension had been treated with radiation, chemotherapy, or a combination of both. None of the untreated patients demonstrated RE marrow extension. A significant association with granulocytopenia was noted in patients with Hodgkin's disease or lymphoma demonstrating RE marrow extension. A similar association was seen in five additional patients with either renal transplant or metastatic carcinoma rendered granulocytopenic by immunosuppression or chemotherapy. Examination of an additional 13 patients with granulocytopenia not associated with chemotherapy did not reveal RE marrow extension. However, RE marrow extension in association with granulocytosis was observed in four of an additional seven patients with acute bacterial infection and no primary hematologic disease. Serial studies in patients with Hodgkin's disease or lymphoma revealed an association between the extending RE marrow pattern and intolerance to chemotherapy in three patients whereas three other patients without marrow extension tolerated chemotherapy well.

These data suggest that RE marrow extension following chemotherapy and radiation is due to compromised hematopoiesis reflected by granulocytopenia. The appearance of an extended RE marrow pattern following chemotherapy appears to be predictive of poor tolerance to further chemotherapy whereas nonextension of the RE marrow reflects adequate marrow granulopoietic reserve. Subclinical infection cannot be completely excluded as a cause of RE marrow extension in patients with chemotherapy-associated granulocytopenia.