A Diagnostic Impact of Serum Autotaxin Levels in Patients with Bone Marrow Fibrosis

Clin Lymphoma Myeloma Leuk. 2023 Feb;23(2):e117-e124. doi: 10.1016/j.clml.2022.12.006. Epub 2022 Dec 7.


Background: Bone marrow (BM) fibrosis is a condition characterized by deposition of reticulin and collagen fibers in BM. It may confer a poor prognosis in some of hematological malignancies. However, the relationship between fibrosis and the disease pathology is not fully understood and no biomarkers for BM fibrosis are available in clinical practice. Autotaxin (ATX) is a secreted enzyme that is associated with various pathophysiological responses, including fibrosis. We conducted a pilot study to investigate the serum ATX levels in various hematological disorders in patients with or without BM fibrosis.

Patients and methods: The serum levels of ATX in a total of 198 patients with hematological disorders and 160 healthy subjects were analyzed. Because of sexual difference in ATX level, the ATX ratio-determined by dividing the ATX level by the mean value of ATX of control subjects of the same sex-was calculated for further comparative analysis. A trephine biopsy samples from 53 patients were also evaluated to determine the Reticulin Fibrosis Index and Collagen Fibrosis Index of each sample.

Results: In comparison to the control group, the ATX ratio was significantly higher in patients, especially those with malignant lymphoma. The ATX ratio in lymphoma patients with BM fibrosis was significantly higher than that in patients without BM fibrosis. The Collagen Fibrosis Index showed statistically significant negative correlation with the ATX ratio.

Conclusion: Our results suggest that the ATX ratio may be a candidate diagnostic biomarker for BM fibrosis in selected patients, including those with malignant lymphoma.

Keywords: ATX ratio; Biomarker; Collagen Fibrosis Index; Pilot study; Reticulin Fibrosis Index.

MeSH terms

  • Collagen
  • Fibrosis
  • Humans
  • Pilot Projects
  • Primary Myelofibrosis* / diagnosis
  • Reticulin


  • Reticulin
  • Collagen