Occasionally it is difficult to distinguish between persistent disease and the presence of hematogones.2-4 Hematogones are nonmalignant lymphoid progenitor cells found in the bone marrow, and are similar to lymphoblasts. Hematogones are usually heterogenous in size and are nonclonal. If the ALL blasts express myeloid markers, the hematogones, by definition, are devoid of these and therefore can be distinguished from leukemia blasts. If the hematogones do not express myeloid markers, it is difficult to distinguish them from leukemia blasts. Most experts would recommend repeating marrow examinations, weekly or every other week, until either the disappearance of the hematogones or emergence of the leukemic clone.
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