Incremental value of the bone marrow trephine biopsy in detecting residual leukemia following treatment for Acute Myeloid Leukemia.
Most guidelines suggest that only the bone marrow aspirate (BMA) is necessary to assess residual disease following intensive chemotherapy for Acute Myeloid Leukemia (AML) with the bone marrow trephine biopsy (BMTB) recommended in cases of a poor quality BMA. We performed a retrospective study evaluating this in a cohort of patients receiving intensive chemotherapy for AML. Residual disease was assessed by morphological examination of the BMA and BMTB±immunohistochemistry. Of the 647 marrows 32.6% were interim marrows performed prior to peripheral count recovery, 41.7% were end of induction (EOI) marrows and the remaining were 'other marrows'. The BMA and BMTB findings were concordant in 92.8% of cases. The BMTB led to a change in diagnosis from 'no leukemia' to 'residual leukemia' in 5.2% of interim, 3.7% of EOI and 2.4% of 'other' marrows. The BMA alone had a sensitivity of 86.8% in detecting residual leukemia and of 82.3%, 82.5% and 94.2% for interim, EOI and 'other marrows', respectively. Despite the high concordance between the BMA and the BMTB the poor sensitivity of the BMA in detecting residual leukemia, particularly at EOI, may lead to an overestimation of the complete remission rates which may have therapeutic and clinical trial implications.
Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada. Electronic address: lsaini@ualberta.ca.
Lalit
L
Saini
Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada. Electronic address: jbrandwe@ualberta.ca.
Joseph
J
Brandwein
Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada. Electronic address: Robert.Turner2@albertahealthservices.ca.
Robert
R
Turner
Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada. Electronic address: loree.larratt@ualberta.ca.
Loree
L
Larratt
Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada. Electronic address: marlene.hamilton@ualberta.ca.
Marlene
M
Hamilton
Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada. Electronic address: anthea1@ualberta.ca.
Anthea
A
Peters
Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada. Electronic address: cynthia.wu@ualberta.ca.
Cynthia
C
Wu
Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada. Electronic address: nancy.zhu@ualberta.ca.
Nancy
N
Zhu
Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada. Electronic address: mtaparia@ualberta.ca.
Minakshi
M
Taparia
Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada. Electronic address: jefferympatterson@gmail.com.
Jeffery M
JM
Patterson
Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada. Electronic address: lauren.bolster@ualberta.ca.
Lauren
L
Bolster
Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada. Electronic address: mjmant@ualberta.ca.
Michael
M
Mant
Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada. Electronic address: Bruce.Ritchie@ualberta.ca.
Bruce
B
Ritchie
Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada. Electronic address: eliew@ualberta.ca.
Elena
E
Liew
Pathology & Laboratory Medicine Institute, Cleveland Clinic Abu Dhabi, Al-Maryah Island, P.O. BOX 112412, Abu Dhabi, UAE. Electronic address: MirzaI@ClevelandClinicAbuDhabi.ae.
Imran
I
Mirza
Department of Laboratory Medicine and Pathology, University of Alberta, 4B1.22 Walter Mackenzie Centre, 8440 112 Street, Edmonton, AB, Canada T6G 2B7, Canada. Electronic address: Graeme.Quest@uhn.ca.
Graeme
G
Quest
Department of Laboratory Medicine and Pathology, University of Alberta, 4B1.22 Walter Mackenzie Centre, 8440 112 Street, Edmonton, AB, Canada T6G 2B7, Canada. Electronic address: Susan.Nahirniak@albertahealthservices.ca.
Susan
S
Nahirniak
Department of Medical Oncology, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada. Electronic address: Sunita.Ghosh@albertahealthservices.ca.
Sunita
S
Ghosh
Department of Medicine, University of Alberta, 116 St. & 85 Ave, Edmonton, AB, Canada T6G 2R3, Canada. Electronic address: irwindee@ualberta.ca.
Irwindeep
I
Sandhu
D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods* / Q000592:standards; D001707:Biopsy, Needle; D001856:Bone Marrow Examination / Q000592:standards*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000175:diagnosis* / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
Acute Myeloid Leukemia; Bone marrow aspirate; Bone marrow trephine biopsy; Sensitivity; Specificity