TY - JOUR
T1 - Blasts-more than meets the eye
T2 - Evaluation of post-induction day 21 bone marrow in CBFB rearranged acute leukemia
AU - Xu, Xiangdong
AU - Duncavage, Eric J.
PY - 2014
Y1 - 2014
N2 - 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.
AB - 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.
KW - Acute myeloid leukemia
KW - Core binding factor beta
KW - Dup98
KW - Inv(16)
KW - Post induction
KW - T(11;20)(p15;q11.2)
KW - day 21 marrow
UR - http://www.scopus.com/inward/record.url?scp=84906262368&partnerID=8YFLogxK
M3 - Article
C2 - 25120841
AN - SCOPUS:84906262368
SN - 1936-2625
VL - 7
SP - 4498
EP - 4502
JO - International Journal of Clinical and Experimental Pathology
JF - International Journal of Clinical and Experimental Pathology
IS - 7
ER -