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The role of bone marrow morphology in the diagnosis of relapsed acute myeloid leukemia

Leukemia volume 32, page 1052 (2018)Cite this article

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We read with interest the recent article by Zhou et al.1 in Leukemia. The authors first demonstrate an almost invariably abnormal multiparameter flow cytometry (MFC) when morphologic exam shows relapse in patients with acute myeloid leukemia (AML). This low false-negative rate of MFC questions the need for morphologic exam when MFC is negative and if the only question is whether the patient has relapsed.

We would like to add another dimension to the observations made by Zhou et al.1 Molecular analysis for somatic mutations using PCR or next-generation sequencing has become a critical component of risk stratification in AML.2 However, how to best use this information in the diagnosis of relapse (both in transplant and non-transplant settings) is not clear. Reappearance or rising titers of NPM1, AML1-MTG8 or PML-RARA transcripts on reverse transcriptase PCR, for example, has been shown to predict hematologic relapse.3, 4, 5 However, the correlation between most other mutations and reappearance of morphologically (and/or flow cytometrically) identified blasts is unknown. This is partly because of our limited knowledge about (i) the independent and cooperative roles of individual mutations in leukemogenesis, and (ii) the effect of mutations on developing cell morphology. As a result, pre-existing or recurrent mutations predictive of relapse can exist in bone marrow biopsy specimens that appear leukemia-free based on morphology and flow cytometry.

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Author contributions

BS and AR developed the concept. BS, SG and AR wrote the manuscript. DW critically evaluated the manuscript.

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  1. Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA

    B Said, D Weisdorf & A Rashidi

  2. Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA

    S Gilles

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  1. B Said
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  2. S Gilles
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Correspondence to A Rashidi.

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Said, B., Gilles, S., Weisdorf, D. et al. The role of bone marrow morphology in the diagnosis of relapsed acute myeloid leukemia. Leukemia 32, 1052 (2018). https://doi.org/10.1038/leu.2017.308

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