Objectives: 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.
Keywords: Acute myeloid leukemia; Allogeneic hematopoietic cell transplantation; Bone marrow biopsy; Minimal residual disease.
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