Is a nadir bone marrow required and, if so, what to do with residual disease?

Current National Comprehensive Cancer Network guidelines for acute myeloid leukemia (AML) treatment state that bone marrow biopsies should be completed 7-10 days after completion of chemotherapy. Treatment decisions change based on cellularity of that biopsy. Several studies show that bone marrow aspirates at nadir can be used to predict complete remission (CR) and overall survival. Many groups have attempted to modify induction regimens based on results of bone marrow biopsies with mixed results. This paper will review the current literature on using bone marrow biopsy to prognosticate and guide treatment for AML patients.