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Implications of delayed bone marrow aspirations at the end of treatment induction for risk stratification and outcome in children with acute lymphoblastic leukaemia
Author(s) -
Zuna Jan,
Moericke Anja,
Arens Mari,
Koehler Rolf,
PanzerGrümayer Renate,
Bartram Claus R.,
Fischer Susanna,
Fronkova Eva,
Zaliova Marketa,
Schrauder André,
Stanulla Martin,
Zimmermann Martin,
Trka Jan,
Stary Jan,
Attarbaschi Andishe,
Mann Georg,
Schrappe Martin,
Cario Gunnar
Publication year - 2016
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.13989
Subject(s) - medicine , minimal residual disease , risk stratification , bone marrow , oncology , surgery
Summary Minimal residual disease ( MRD ) at the end of induction therapy is important for risk stratification of acute lymphoblastic leukaemia ( ALL ), but bone marrow ( BM ) aspiration is often postponed or must be repeated to fulfil qualitative and quantitative criteria for morphological assessment of haematological remission and/or MRD analysis. The impact of BM aspiration delay on measured MRD levels and resulting risk stratification is currently unknown. We analysed paired MRD data of 289 paediatric ALL patients requiring a repeat BM aspiration. MRD levels differed in 108 patients (37%) with a decrease in the majority (85/108). This would have resulted in different risk group allocation in 64 of 289 patients (23%) when applying the ALL ‐Berlin‐Frankfurt‐Münster 2000 criteria. MRD change was associated with the duration of delay; 40% of patients with delay ≥7 days had a shift to lower MRD levels compared to only 18% after a shorter delay. Patients MRD ‐positive at the original but MRD ‐negative at the repeat BM aspiration ( n = 50) had a worse 5‐year event‐free survival than those already negative at first aspiration ( n = 115) (86 ± 5% vs. 94 ± 2%; P = 0·024). We conclude that BM aspirations should be pursued as scheduled in the protocol because delayed MRD sampling at end of induction may result in false‐low MRD load and distort MRD ‐based risk assessment.