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Updated: Aug 13, 2026
Comprehensive Protocol to Sample and Process Bone Marrow for Measuring Measurable Residual Disease and Leukemic Stem Cells in Acute Myeloid Leukemia
Published on: March 5, 2018
Abstract:
Among 195 patients with variants of acute myelogenous leukemia (AML), a minimum of 11 met our criteria of smouldering AML: patients with less than 30% of blast cells plus promyelocytes in the bone marrow at the time of diagnosis who were observed without specific antileukemic therapy for a period of at least 6 months without entering a fulminant stage of the disease. These patients were older than other patients with AML, they had initially relatively few infections, bled rarely, and did not enter the fullblown clinical picture typical of acute leukemia until the last months of life. For these 11 patients the median survival time was 29 months from the time of diagnosis. Patients with smouldering leukemia shall be observed carefully and not be given specific antileukemic therapy, at least not before they flare into a blast crisis. Transfusions, antibiotics and a small dose of prednisone should be given when necessary.
Insights
Smouldering acute myelogenous leukemia (AML) is a distinct subtype characterized by fewer than 30% blasts and slow progression. This variant shows a median survival of 29 months, suggesting observation over immediate therapy.
Area of Science:
- Hematology
- Oncology
- Internal Medicine
Background:
- Acute myelogenous leukemia (AML) encompasses diverse clinical presentations.
- Identifying distinct AML subtypes is crucial for tailored patient management.
Observation:
- A subset of 11 out of 195 AML patients met criteria for smouldering AML.
- Smouldering AML patients had <30% bone marrow blasts and promyelocytes at diagnosis.
- These patients exhibited slower disease progression, fewer initial infections, and less bleeding compared to typical AML.
Findings:
- Smouldering AML patients were older and presented with a less aggressive initial clinical picture.
- The median survival time for smouldering AML patients was 29 months from diagnosis.
- Disease progression to fulminant AML occurred later in the disease course.
Implications:
- Smouldering AML warrants careful observation rather than immediate aggressive antileukemic therapy.
- Supportive care, including transfusions, antibiotics, and corticosteroids, should be administered as needed.
- Distinguishing smouldering AML may refine treatment strategies and improve patient outcomes.
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