RELATIONSHIP BETWEEN BONE MARROW MYELOGRAM PARAMETERS AND PERIPHERAL BLOOD INDICES IN CHEMOTHERAPY-INDUCED LEUKOPENIA
Keywords:
chemotherapy-induced leukopenia; neutropenia; granulopoiesis; bone marrow; myelogram; peripheral blood; G CSF; myelosuppressionAbstract
Aim: To analyze contemporary data on chemotherapy-induced leukopenia with a focus on the relationship between bone marrow myelogram parameters and peripheral blood indices, and to assess how accurately peripheral blood reflects the true state of granulopoiesis in the bone marrow.
Materials and Methods: A narrative literature review was performed using publications from 2020–2025 in Russian and international journals. Priority was given to studies evaluating mechanisms of chemotherapy-induced myelosuppression, patterns of granulopoiesis disruption, bone marrow morphology (myelogram), and the dynamics of peripheral blood counts (ANC, leukocyte differential) under cytotoxic therapy with or without G‑CSF support. Clinical guidelines, methodological manuals on bone marrow cytology, and works using mathematical modelling of granulopoiesis were also analyzed.
Results: Peripheral blood indices (total leukocyte count, ANC, leukocyte differential, and their dynamics between chemotherapy cycles) reliably reflect the clinical severity of myelosuppression, the risk of febrile neutropenia, and the need for G‑CSF prophylaxis or dose modifications. However, identical degrees of leukopenia and neutropenia in peripheral blood may correspond to fundamentally different bone marrow patterns: preserved early myeloid progenitors with a maturation block, depletion of the pool of mature granulocytes, or pronounced hypo-/aplasia with global suppression of myelopoiesis. Myelogram provides a morphological substrate of these states (cellularity, lineage ratios, maturation indices, ineffective granulopoiesis, hypoplasia, infiltration), allowing discrimination between central production failure and redistribution or peripheral destruction mechanisms. Dynamic and modelling studies demonstrate that serial peripheral counts can partially reconstruct granulopoiesis recovery kinetics, yet they remain indirect and do not replace morphological assessment in prolonged or atypical cytopenias.
Conclusion: Peripheral blood reflects the clinical manifestation of chemotherapy-induced myelosuppression, whereas the myelogram characterizes the morphological basis of disturbed granulopoiesis; the concordance between these two levels of assessment is incomplete. This discrepancy justifies the need for dedicated correlation studies in homogeneous cohorts of cancer patients to define when peripheral blood can be used as a sufficient surrogate of marrow status and when bone marrow examination is mandatory.
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