Continuous Indexing of Fibrosis (CIF): Improving the Assessment and Classification of MPN Patients

Abstract: The detection and grading of fibrosis in myeloproliferative neoplasms (MPN) is an important component of disease classification, prognostication and disease monitoring. However, current fibrosis grading systems are only semi-quantitative and fail to capture sample heterogeneity. To improve the detection, quantitation and representation of reticulin fibrosis, we developed a machine learning (ML) approach using bone marrow trephine (BMT) samples (n = 107) from patients diagnosed with MPN or a reactive / nonneoplastic marrow. The resulting Continuous Indexing of Fibrosis (CIF) enhances the detection and monitoring of fibrosis within BMTs, and aids the discrimination of MPN subtypes. When combined with megakaryocyte feature analysis, CIF discriminates between the frequently challenging differential diagnosis of essential thrombocythemia (ET) and pre-fibrotic myelofibrosis (pre-PMF) with high predictive accuracy [area under the curve = 0.94]. CIF also shows significant promise in the identification of MPN patients at risk of disease progression; analysis of samples from 35 patients diagnosed with ET and enrolled in the Primary Thrombocythaemia-1 (PT-1) trial identified features predictive of post-ET myelofibrosis (area under the curve = 0.77). In addition to these clinical applications, automated analysis of fibrosis has clear potential to further refine disease classification boundaries and inform future studies of the micro-environmental factors driving disease initiation and progression in MPN and other stem cell disorders. The image analysis methods used to generate CIF can be readily integrated with those of other key morphological features in MPNs, including megakaryocyte morphology, that lie beyond the scope of conventional histological assessment.