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The common idea that AML is a homogeneous disease of the bone marrow is challenged by the occurrence of extramedullary infiltrations (EMIs). EMIs can usually take the form of either diffuse organ infiltration (lungs, liver, spleen, gums, and meninges) or localized disease in the form of a mass (chloroma or granulocytic sarcoma), nodules/plaques in the skin (leukemia cutis), or other organs, identifiable clinically or by morphometabolic imaging. 2

The clonal architecture of AML has mainly been studied in the bone marrow. 3 However, the spatial diffusion in the body remains poorly understood. EMI is a frequent problem in the clinic, and its role in relapse after chemotherapy or after allogeneic stem cell transplantation is rarely explored in the literature. Indeed, as recently reviewed, 4 cohort studies reported conflicting prognostic implications of EMI. In a large retrospective series of the ECOG-ACRIN Cancer Research …