Diagnostic Accuracy of Bone Marrow Morphology to Determine Remission in Acute Lymphoblastic Leukemia Children: The Role of Minimal Residual Disease

Abstract

Background: Relapse in acute lymphoblastic leukemia (ALL) patients are still widely found even though most patients experience remission at the end of the induction phase. Inaccurate determination of remission status due to the remaining leukemic cells that cannot be detected by bone marrow morphology examination is thought to play a considerable role in the occurrence of relapse.Objective: To measure the accuracy of the bone marrow morphology in determining remission at the end of the induction phase of ALL.Methods: Diagnostic tests were carried out in pediatric ward and laboratory of Sanglah Hospital and Dharmais Cancer Hospital Jakarta in January 2017 to March 2019. Bone marrow morphology and minimal residual disease (MRD) test was performed on ALL children at the end of the induction phase. Minimal residual disease is the gold standard.Results: Forty subjects with a median age of 5 years were included in this study. The median duration of induction phase was 75 days. Thirty-eight subjects (95%) had complete remission by bone marrow morphology, while only 16 (40%) subjects had complete remission by MRD. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of bone marrow morphology in this study were 100%, 8.3%, 42.1% and 100% respectively. Area under the curve (AUC) value of bone marrow morphology was 0.521 (95% CI 0.338 - 0.704). Conclusion: Bone marrow morphology has high sensitivity but low specificity and PPV in determining remission at the end of the induction phase of children with ALL.Â