CRJ, values in 9 patients before therapy, after the first 2 before mean, 18 and after 2 courses mean, 55 is sig- courses of chemotherapy and at the end of induction therapy. There were no signs c. These values are a little lower than the pretreatment values; the difference, however, is not FIG. Relation between leukocyte nadir during the first course of significant mean, The decrease between chemotherapy and the CFU, count after 2 courses.
In SCLC, high-dose chemotherapy with autologous In nine patients, CFU, counts were performed se- bone marrow as a primary therapy has led to a high quentially during induction therapy Fig.
In these 9 number of remissions. The moment that is chosen to harvest the marrow might influence the outcome of the procedure. Harvesting bone CFU, Count During Maintenance Therapy marrow before therapy has started would have the ad- In five patients, after 6 months of chemotherapy, values vantage that stem cell numbers are not committed by in the normal range were found 1 per I O5 cells ; in cytostatics.
However, SCLC is often, at the start of treat- 5 of 6 patients, an abnormally low value was found after ment, already metastasized, with a high risk of contam- 12 months of treatment per 10' cells. Count This study shows that after 2 courses of chemotherapy, the mean CFU, count is 3. Our results are comparable before therapy in patients with ED and LD, leukocytes to those of Abrams el a1. Granulocytes counts was 6. Hemoglobin levels, CFU, determinations only measure a part of the bone There were no while information.
Erythroid precursors seem to be more differences in leukocyte nadir mean, 1. A low leukocyte marrow. Potentially, assays that give rise to mixed colonies nadir during the first course of CCV is related to high should more closely mirror the presence of stem cells.
High dose nitrogen mustard NH2 with autologous non frozen bone marrow transplantation in advancd malignant melanoma. Blut number of CFU,s infused and the time to hemopoietic I98 1; Successful engraftment of cryopreserved autologous bone marrow in patients with malignant lymphoma. Blood Marrow autotrans- co-trimoxazole, it is possible that this has caused a delay plantation accelerates haematological recovery in patients with malignant of hematopoietic recovery.
Br J Cancer ; In this study, a substantial increase was found in CFU, 9. Spitzer G, Verna DS. Fisher R et al. The myeloid progenitor cell: counts following severe chemotherapy-induced leuko- Its value in predicting hematopoietic recovery after autologous bone penia, the increase being related to the degree of leuko- marrow transplantation.
Ekert H. Ellis M, Waters KD. Taurog P. Autologous bone marrow penia. This increase seems to be more overt when the rescue in the treatment of advanced tumors of childhood.
Cancer ; pretreatment CFU, counts are low. In our material, in- Human bone marrow colony growth in agar-gel. J Cell Physiol High dose cyclophos- probably dependent on the degree of invasion.
The in- phamide with autologous marrow transplantation as initial treatment crease in CFU, count in patients with discrete marrow of small cell carcinoma of the bronchus. High dose combination of colony stimulating factor by tumor cells.
Cancer Late dosage in- not lead to further increase in CFU, count. The abnormal tensification with autologous bone marrow rescue in small cell lung growth pattern reported by McCarthy and coworkers,23 cancer Abstr. Taken in combination with peripheral blood monitoring, there is potential to predict response minimizing the need for an invasive testing. Dynamic contrast-enhanced magnetic resonance imaging DCE-MRI provides global and functional imaging of bone marrow angiogenesis as compared to traditional MRI which uses radio waves in a magnetic field to identify anatomy.
In the studies conducted, DCE-MRI has been examined as a predictor for overall survival using a calculated peak enhancement ratio Peak and quantification of vascularity Amp.
In 78 de novo AML patients, those with a low Peak and Amp at diagnosis had an improved disease free survival and overall survival compared to patients with a high Peak and Amp. Future imaging studies have the potential to answer some important outstanding questions before imaging technology can be incorporated into standard assessments for AML monitoring: 1 Which imaging technique most accurately reflects the total burden of disease? Bone marrow evaluation, therefore, remains an important adjunct to peripheral blood analysis in patients with AML, and perhaps always will since some patients do not have circulating peripheral blood blasts.
The recently published WHO guidelines for the diagnosis of AML still espouse morphology as the most important characteristic for the diagnosis and management of myeloid neoplasms, 3 though more modern techniques may threaten the hegemony of morphology, as the biology underlying this diverse set of malignancies is better elucidated. While it is likely that highly sensitive tools will be increasingly used on peripheral blood for response assessment and to monitor for clinical relapse, at present, sampling of the bone marrow compartment remains an important component of initial AML diagnosis and at the end of induction treatment in the majority of patients.
Figure 1 summarizes the current recommendations for bone marrow evaluation, as well as areas for possible future modifications to the algorithm as methods for diagnosis and monitoring of AML are refined. The possible future landscape for diagnosis and monitoring of acute myeloid leukemia at various time points during treatment and subsequent surveillance. The current schema follows the guidelines of the National Comprehensive Cancer Network and others.
In the future, we posit that advances in flow cytometry and sequencing and possibly imaging may circumvent our current reliance on morphology and cytogenetics. Though the current sensitivity of bone marrow testing is generally fold higher than in the peripheral blood, many tests may be done on peripheral blood only in the future. Timing of surveillance monitoring for measurable residual disease on the peripheral blood will likely depend on the abnormalities being followed for a particular patient.
In an aging population experiencing an increased incidence in AML de novo, progression from MDS, and treatment related , it is imperative that we consider the patient's ability, willingness, and pain threshold in continuing to do bone marrows. Table 2 summarizes the pros and cons of peripheral blood versus bone marrow sampling for diagnosis and monitoring of AML. Notably, clinical trials often include patients with the best performance status, and the findings generated by such patients may not hold true for the general population.
Easily accessible, especially for patients with semi-permanent intravenous catheters in place. Painful procedure for the patient, which patient may not want to undergo with frequency. Unclear role of monitoring for response with less intensive therapies, including hypomethylating agents and targeted inhibitors. The day 14 marrow is of questionable clinical utility, since it is predictive of CR rates, but not of OS.
Marrow sampling at count recovery after induction chemotherapy is critical for response assessment; patients with a morphologic CR but evidence of MRD have worse outcomes. The recommended frequency of marrow sampling for less intensive therapies, such as with targeted inhibitors, is unclear. Novel imaging technology, using both PET and MRI, may have a role in future monitoring of AML patients, though many questions still remain about the predictive ability, utility, and cost.
Conflict of interest : C. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript.
The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
National Center for Biotechnology Information , U. Blood Rev. Author manuscript; available in PMC Jul 1. Christopher S. Author information Copyright and License information Disclaimer. Copyright notice. The publisher's final edited version of this article is available at Blood Rev. See other articles in PMC that cite the published article. Abstract The diagnosis of acute myeloid leukemia AML can be made based on peripheral blood or bone marrow blasts.
Keywords: Acute myeloid leukemia, Bone marrow evaluation, Flow cytometry, Morphology, Measurable residual disease. Use of marrow in initial diagnosis 1. Use of marrow in response assessment 2. Peripheral Blood Monitoring 3. Table 1 The authors' viewpoint on necessity of bone marrow evaluation at standard times during the course of AML diagnosis therapy. Time point Is bone marrow evaluation necessary?
Why or why not? Additionally, for gene expression PCR-based MRD monitoring, peripheral blood may be superior to bone marrow due to high background rates in the bone marrow. Open in a separate window. Future directions Bone marrow evaluation, therefore, remains an important adjunct to peripheral blood analysis in patients with AML, and perhaps always will since some patients do not have circulating peripheral blood blasts.
Figure 1. Table 2 Pros and cons of sampling from the peripheral blood and bone marrow in AML. Footnotes Conflict of interest : C. References 1. Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet.
Acute myeloid leukemia, version 2. The revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Prognostic relevance of integrated genetic profiling in acute myeloid leukemia. N Engl J Med. Mutations and treatment outcome in cytogenetically normal acute myeloid leukemia. Prognostic significance of the European LeukemiaNet standardized system for reporting cytogenetic and molecular alterations in adults with acute myeloid leukemia. J Clin Oncol.
Long-term prognosis of acute myeloid leukemia according to the new genetic risk classification of the European LeukemiaNet recommendations: evaluation of the proposed reporting system. Appelbaum FR. Indications for allogeneic hematopoietic cell transplantation for acute myeloid leukemia in the genomic era.
Use of surface marker analysis to predict outcome of adult acute myeloblastic leukemia. Cell cycle status in AML blast cells from peripheral blood, bone marrow aspirates and trephines and implications for biological studies and treatment. Br J Haematol. Use of peripheral blood blasts vs bone marrow blasts for diagnosis of acute leukemia. Am J Clin Pathol. Grimwade D, Freeman SD. Peripheral blood cytogenetic studies in hematological neoplasms: predictors of obtaining metaphases for analysis.
Eur J Haematol. Development and validation of a comprehensive genomic diagnostic tool for myeloid malignancies. High correlation of the proteome patterns in bone marrow and peripheral blood blast cells in patients with acute myeloid leukemia.
J Transl Med. Proposals for the classification of the acute leukaemias. Proposed revised criteria for the classification of acute myeloid leukemia. Ann Intern Med. Orazi A. Acute myeloid leukemia ontogeny is defined by distinct somatic mutations. Surface marker analysis of acute myeloblastic leukemia: identification of differentiation-associated phenotypes.
Cancer Genome Atlas Research N. Genomic and epigenomic landscapes of adult de novo acute myeloid leukemia. The need for a bone marrow examination in all children with suspected idiopathic thrombocytopenic purpura ITP has been challenged in recent years. By definition, ITP is a diagnosis of exclusion, which means that all known entities that can cause thrombocytopenia have been excluded by a clinical assessment that includes a history, physical examination, and appropriate laboratory tests. There are many diseases that, because of their typical clinical manifestations, do not rely on a bone marrow examination for determining the cause of the thrombocytopenia.
Examples include hypersplenism, systemic lupus erythematosus, disseminated intravascular coagulation, septicemia, hemolytic-uremic syndrome, and familial thrombocytopenia. Since children with ITP have a typical presentation and course, why have we insisted on bone marrow examinations as part of our routine?
After all, the bone marrow morphologic findings are nondiagnostic in ITP. However, it helps subdivide the patients with thrombocytopenia into those with adequate to increased megakaryocytes and those with. Am J Dis Child. Coronavirus Resource Center.
0コメント