Concordance between Bone Marrow Aspiration and Bone Marrow Biopsy to Evaluate Response after Induction Chemotherapy in Acute Myeloid Leukemia at Siriraj Hospital

Abstract

Background: The standard treatment for acute myeloid leukemia (AML) is chemotherapy, together with stem cell transplantation if indicated. Bone marrow study, comprising bone marrow aspiration and bone marrow biopsy, is the current method to evaluate treatment response. While many guidelines recommended evaluating treatment response with only bone marrow aspiration, it has still been a routine practice at Siriraj Hospital to perform both bone marrow aspiration and biopsy. Confirming the concordance of the two methods would help decrease the need to perform bone marrow biopsy, reducing patient discomfort, procedure time, and cost.

Objectives : The study aimed to determine the concordance between bone marrow aspiration and bone marrow biopsy in evaluating treatment response among patients with  AML receiving the ‘3+7 regimen’.

Method: The data of patients receiving a diagnosis of AML were evaluated for response after standard ‘3+7’ induction therapy by both bone marrow aspiration and biopsy, between January 1, 2012 and December 31, 2021 were retrospectively reviewed. Results from both bone-marrow-study methods were interpreted as either ‘complete remission’ or ‘residual disease’ and then were analyzed as either ‘concordance’ or ‘discordance’. The primary outcome was percentage of patients with ‘concordance’ bone marrow study.

Results: A total of 725 individuals were identified as patients receiving a diagnosis of AML receiving inpatient care, of which the bone marrow studies of 233 were analyzed. Overall, 181 patients (77.7%) had concordant result. Of the 52 patients with discordant result, 14 patients (26.9%) had inadequate bone marrow aspirate specimen while 3 patients (5.8%) had inadequate bone marrow biopsy specimen.

Conclusion: Among patients receiving a diagnosis of AML receiving ‘3+7 regimen’, 77.7% had concordant results between bone marrow aspiration and bone marrow biopsy. The identifiable cause of discordant result was mostly from inadequate bone marrow aspirate specimens.