Table 2.

Pros and cons of sampling from the peripheral blood and bone marrow in AML.

Peripheral blood	Bone marrow
Pros
Easily accessible, especially for patients with semi-permanent intravenous catheters in place	Higher sensitivity by 10× than expected from peripheral blood for MRD monitoring, except for gene expression PCR-based tests
If absolute peripheral blast count >2,000/μl, sufficient for diagnosis of AML and further characterization (morphology, karyotype, and molecular studies) Higher sensitivity than bone marrow for MRD monitoring for gene expression PCR-based tests (e.g., WT1)99	Generally referred to in guidelines for treatment/monitoring; often required for clinical trials
Cons
Decreased sensitivity	Painful procedure for the patient, which patient may not want to undergo with frequency
Unclear role of monitoring for response with less intensive therapies, including hypomethylating agents and targeted inhibitors	More expensive
	May require extra staff and monitoring (e.g., for conscious sedation)
	Unclear role of monitoring for response with less intensive therapies, including hypomethylating agents and targeted inhibitors

Abbreviations: AML (acute myeloid leukemia); MRD (measurable residual disease)