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Negative initial bone marrow aspirate does not rule out acute lymphoblastic leukemia
  • Monica Davini,
  • Kevin Shiah,
  • Anurag Agrawal
Monica Davini
University of Arizona

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Kevin Shiah
Touro University California College of Osteopathic Medicine
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Anurag Agrawal
UCSF Benioff Children's Hospital Oakland
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Patients with precursor-B-cell acute lymphoblastic leukemia (B-ALL) may initially present with a prodrome, cytopenia(s) with abnormal bone marrow cellularity, but without clonal abnormalities. Prior cases of “indolent ALL” report infections preceding B-ALL diagnosis. Here we describe our institutional experience, eight patients over a 15-year period with a prodrome (2% of B-ALL diagnoses) prior to definitive diagnosis. Patients ranged from 3-15 years of age (median 5 years), requiring a median 3.5 months from presentation to diagnosis, with a median 3 bone marrow aspirates (BMA) to reach definitive diagnosis. Practitioners must be aware that initial negative BMA does not rule out B-ALL.