Blasts-more than meets the eye: Evaluation of post-induction day 21 bone marrow in CBFB rearranged acute leukemia

Xiangdong Xu, Eric J. Duncavage

Research output: Contribution to journalArticlepeer-review

Abstract

Induction chemotherapy is often the first therapeutic intervention for acute myeloid leukemia (AML). Evaluation of post induction bone marrow provides critical information for clinical management; in general increased blast counts or increased marrow cellularity is an ominous sign, suggestive of ineffective therapy, and may warrant additional rounds of chemotherapy. However, increased blasts alone are not necessarily predictive of recurrent/persistent disease. Here we report a very unusual observation in a case of AML with a core binding factor beta (CBFB) rearrangement. In this case the day 21 post-induction marrow biopsy showed a high blast count (approximately 20%), however, subsequent fluorescence in-situ hybridization studies were negative for CBFB rearrangement. We compared this finding to post-induction marrows from a series of 6 AML cases with CBFB rearrangements, none of which showed an increased blast count. This case illustrates that increased blast counts, even those comprising 20% of cells, are not de facto evidence of induction failure, and that correlation with ancillary studies such as fluorescence in-situ hybridization should be used to distinguish a persistent neoplastic clone, from a brisk marrow recovery.

Original languageEnglish
Pages (from-to)4498-4502
Number of pages5
JournalInternational Journal of Clinical and Experimental Pathology
Volume7
Issue number7
StatePublished - 2014

Keywords

  • Acute myeloid leukemia
  • Core binding factor beta
  • Dup98
  • Inv(16)
  • Post induction
  • T(11;20)(p15;q11.2)
  • day 21 marrow

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