What tests will I need to do for my acute myeloid leukemia and how often?

What tests will I need to  
do for my AML and how often?  

So ideally, the testing that a patient  

would require for acute myeloid leukemia  
leukemia would be a bone marrow biopsy.  

would require for acute myeloid leukemia  
leukemia would be a bone marrow biopsy.  

So we take a little piece of the spongy  
part of the inner part of the bone in the hip,  

and that is where the bone marrow resides.  

We also, when we enter the bone marrow,  
we pull out what's called the aspirate,  

which is the blood in the center  
of that spongy tissue,  

to really help us understand  
what the cells look like,  

so what these immature blasts look like,  
those characteristics are important to us.  

The number of those  
blasts are important to us.  

And then that's  
where we pull the genetic information.  

Sometimes we're able  
to get that information from the blood.  

Sometimes you miss  
some of the sort of, low level variance  

that might be expressed in those patients,  
but it's possible to do the full workup  

from the blood alone,  
just depending on the burden of illness.  

And then once we have a diagnosis,  
there are a lot of blood tests ahead,  

and because so much is required  
of patients in terms of blood draws,  

we do generally recommend  
that patients have a central catheter.  

So either a PICC line or a port  
to help us easily draw those lab values  

and help us easily support  
them back with transfusions.  

So there are bone marrow biopsies  
often along the way.  

So the first one usually comes  
after the first bit of treatment  

where we try to see  
if the leukemia is gone or not.  

And then future biopsies really depend on  

what your future treatment is after that.  

So typically there's the first treatment  
that gets the leukemia to go away.  

And then future treatments  
are to keep it away.  

So if it's a few more rounds of chemo,  
at the end of that chemotherapy  

we get another bone marrow biopsy  
to ensure the leukemia is still gone.  

If after you get the leukemia to go away,  

if we know there's still a high chance  
that it might come back,  

sometimes patients will go on  
to a stem cell transplant.  

Once you have a stem cell transplant,  

there's several biopsies that follow that as well.  

And it's all to ensure  
that we're not missing  

any leukemia that might  
be trying to come back.  

So when managing someone's AML,  
there are several tests that will be done.  

But most common and most often,  
it will be a bone marrow biopsy,  

because the cancer lives in the marrow.  

We need to go back to that  
source to assess  

how well it's responding to treatment.  

So a patient will get a bone  
marrow biopsy, which will tell us,  

you know, how prevalent  
the disease is at diagnosis.  

And then we like to repeat  
a bone marrow biopsy  

after the first, or the first two or  
three rounds of chemotherapy  

to see how well they responded.  

We use CT scans on staging to see  

if there's any evidence of disease  
outside the marrow, but that is rare.  

So moving forward, once we've  
started treatment,  

performing just routine bloodwork like a CBC,  
looking at blood counts,  

performing a bone marrow biopsy once  
every cycle or in a lot of cases,  

once every few cycles, gives us  
an idea of how to monitor  

the prevalence of blast or leukemia  
cells in somebody's bone marrow.  

And then, more and more frequently  
now, we're utilizing what we call MRD  

or measurable residual disease,  
which is a way that we can track  

the mutated genes or mutated  
characteristics of  

acute myeloid leukemia at a very  
low molecular microscopic level,  

because in theory, the lower  
you can eradicate a disease,  

if we can monitor that to a very  
low level, then we can also see  

at a very low level that it's starting  
to come back before it actually does.  

And that's what relapse is.  

So in some patients with certain  
mutations, we're actually able  

to do those tests, those MRD tests  
either on blood or bone marrow,  

which that's been a big game  
changer in AML management.