Work

A tale of two sites – Distinct spatial differences between bone marrow and extramedullary AML

Year: 2026

Type: article

Abstract: Acute myeloid leukemia (AML) is the most common acute leukemia in adults and remains associated with poor overall survival. Beyond genetic factors in the bone marrow (BM) that drive clonal evolution, leukemic progression, immune evasion, and therapy resistance, far less is known about extramedullary (EM) AML, a clinically relevant manifestation characterized by leukemic infiltration of peripheral tissues and frequently associated with adverse outcomes. This review focuses on the spatial heterogeneity of AML, differentiating between BM and EM disease, elucidating how niche components shape leukemic behavior, clonal evolution, and treatment resistance. Furthermore, we review current clinical practice and evidence for the clinical approach, diagnostic management, and treatment of patients with EM AML. At last, we highlight the transformative role of spatial analysis platforms, enabling high-resolution mapping of niche cell and leukemic cell interactions and discuss their potential to improve diagnosis and personalized therapeutic strategies for EM AML.

Source: Blood Reviews

DOI: 10.1016/j.blre.2026.101416

Authors: Hossein Emami, Annette I. Garbe, Karin Huber, Friedrich Stölzel, Julia Frimmel

Institution: University Hospital Schleswig-Holstein

Language: English

Topic: Acute Myeloid Leukemia Research

Subfield: Hematology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $5,220