title: Bone marrow evaluation for diagnosis and monitoring of acute myeloid leukemia.
abstract: The diagnosis of acute myeloid leukemia (AML) can be made based on peripheral blood or bone marrow blasts. In this review, we will discuss the role of bone marrow evaluation and peripheral blood monitoring in the diagnosis, management, and follow up of AML patients. For patients with circulating blasts, it is reasonable to perform the necessary studies needed for diagnosis and risk stratification, including multiparametric flow cytometry, cytogenetics, and molecular analysis, on a peripheral blood specimen. The day 14 marrow is used to document hypocellularity in response to induction chemotherapy, but it is unclear if that assessment is necessary as it often does not affect immediate management. Currently, response assessments performed at count recovery for evaluation of remission and measurable residual disease rely on bone marrow sampling. For monitoring of relapse, peripheral blood evaluation may be adequate, but the sensitivity of bone marrow testing is in some cases superior. While bone marrow evaluation can certainly be avoided in particular situations, this cumbersome and uncomfortable procedure currently remains the de facto standard for response assessment.
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. Electronic address: mperciva@uw.edu.
authors.forename: Mary-Elizabeth
authors.initials: ME
authors.lastname: Percival
authors.affiliation: Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Lai
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Elihu
authors.initials: E
authors.lastname: Estey
authors.affiliation: Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hourigan
mesh_terms: D000818:Animals; D001853:Bone Marrow / Q000473:pathology*; D005434:Flow Cytometry / Q000379:methods; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D008279:Magnetic Resonance Imaging / Q000379:methods; D018365:Neoplasm, Residual / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D049268:Positron-Emission Tomography / Q000379:methods; D011379:Prognosis
keywords: Acute myeloid leukemia; Bone marrow evaluation; Flow cytometry; Measurable residual disease; Morphology