Evaluation of Remission

In a patient treated with acute leukemia, CR is considered when peripheral blood cell counts approach the normal range, and the bone marrow is normocellular and shows orderly maturation of hematopoietic cells with less than 5 percent blast cells. The criteria for morphological remission of less than 5 percent bone marrow blasts are arbitrary. The leukemic blasts in AML M3 or ALL L3, or blasts containing Auer rods can be readily identified, even when present in small numbers. Persistence of dysplastic hematopoiesis in a patient who might otherwise fulfill the criteria for CR results in a much higher relapse rate.

The current technology is redefining remission. The presence of leukemic blast cells at a level typically under detectable with conventional morphological evaluation is referred to as minimal residual disease. The presence of increased precursor B cells or hematogones in the bone marrow of patients with treated precursor B-ALL may pose a diagnostic dilemma with regard to differentiating hematogones from residual or recurrent leukemia. Differentiating hematogones from leukemic B cells can be challenging, given their morphological similari-ties148 and often-identical immunological profiles.149 In distinguishing hematogones from leukemic blast cells in a patient with precursor B-ALL who is in morphological remission, using markers of clonality such as PCR for IgH and TCR gene rearrangements150-152 and frequently occurring specific translocations153,154 or deletions have been suggested. The role of FISH is also being explored. Although a positive result may indicate the presence of a small population of clonal cells, whether it necessarily reflects an increased predilection for subsequent morphological relapse is uncertain.

10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.

Get My Free Ebook


Post a comment