title: Prognostic Significance of Residual Acute Myeloid Leukemia in Bone Marrow Samples Taken Prior to Allogeneic Hematopoietic Cell Transplantation.
abstract: OBJECTIVE
  We sought to identify features in routine evaluation of pre-hematopoietic cell transplantation (HCT) bone marrow samples from patients with acute myeloid leukemia (AML) that influenced patient outcome.
  
  
  METHODS
  Of 140 patients, evidence of residual leukemia (RL) was identified in 38 (27%) of pre-HCT samples, as defined by 5% or more aspirate blasts, increased blood blasts, clustered or necrotic blasts on biopsy specimens, and/or leukemia-associated karyotypic abnormalities.
  
  
  RESULTS
  Morphologic or karyotypic evidence of RL was significantly associated with shorter leukemia-free survival (LFS) compared with cases without identifiable RL (median, 7.1 vs 28.3 months; P  < .0001). Upon multivariable analysis, RL, prior relapse, age, high-risk karyotype, and alternate donor source were each independently associated with shorter LFS. RL in pre-HCT samples was more strongly associated with shorter LFS in patients with intermediate or favorable-risk AML karyotype ( P  = .001) than secondary or adverse karyotype-risk AML ( P  = .04).
  
  
  CONCLUSIONS
  Rigorous morphologic and karyotypic evaluation of pretransplant marrows is practical and important for posttransplant prognosis.
authors.affiliation: From the Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN; and Departments of.
authors.forename: Alexandra E
authors.initials: AE
authors.lastname: Kovach
authors.affiliation: Hematology/Oncology.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Brunner
authors.affiliation: Hematology/Oncology.
authors.forename: Amir T
authors.initials: AT
authors.lastname: Fathi
authors.affiliation: Hematology/Oncology.
authors.forename: Yi-Bin
authors.initials: YB
authors.lastname: Chen
authors.affiliation: Pathology, Massachusetts General Hospital, Boston.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Hasserjian
mesh_terms: D000328:Adult; D000368:Aged; D001853:Bone Marrow / Q000473:pathology; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D015470:Leukemia, Myeloid, Acute / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D055815:Young Adult
keywords: Acute myeloid leukemia; Allogeneic hematopoietic cell transplantation; Bone marrow biopsy; Minimal residual disease