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The Day 14 marrow: checking if induction worked | CION Cancer Clinics
The Day 14 bone marrow test checks whether the first round of AML chemotherapy has cleared leukaemia cells from the marrow. An empty marrow is the hoped-for result. Leukaemia still present usually means a change of plan, not an end to options. This page explains the test, the report words and what it cannot tell you about the outlook. At CION Cancer Clinics, every leukaemia, MDS and MPN case is reviewed by our haematologist and discussed at a tumour board before a plan is agreed.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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The short answer
What is the Day 14 bone marrow test checking?
The Day 14 marrow checks whether the first round of chemotherapy has emptied the bone marrow of leukaemia cells. It is taken about two weeks after induction starts, and it tells the team whether to wait for recovery or plan a second round sooner.
Why the timing matters
Induction chemotherapy is meant to clear out the marrow, the soft factory inside your bones where blood is made. At this point the marrow should look almost empty. That is the aim, not a problem. If leukaemia cells are still clearly there, waiting longer rarely helps, so the team can act early.
Not every centre does it
Some haematology teams do a marrow at this stage for everyone. Others skip it and wait for the recovery marrow, taken once the blood counts come back up. Both approaches are used around the world. If your parent was not given a Day 14 marrow, it does not mean something was missed. Ask the team which plan they follow and why.
The Day 14 result is an early check. The test that decides whether remission has been reached comes later, after the counts recover.On the day
What happens during the marrow test?
Getting ready
It is usually done on the ward, at the bedside. Because platelets are very low at this stage, the team checks the blood counts first and may give a platelet transfusion before starting. You can usually eat and drink as normal.
Numbing the skin
The person lies on their side. The back of the hip bone is cleaned and numbed with an injection. Some people are also given a mild sedative to help them relax. The numbing stings for a few seconds.
Taking the sample
A needle is passed into the bone to draw out liquid marrow. A second, slightly wider needle may take a small core of bone. There is a deep pulling ache for a moment, and the whole procedure takes minutes.
Afterwards
Pressure is held on the spot and a dressing goes on. The site can be sore for a few days. Tell the nurse at once if the dressing soaks through with blood or the area swells.
Not sure whether this applies to you?
Ask an oncologistReading the result
What can the Day 14 result show?
There are broadly three kinds of answer. Your haematologist reads the result together with the blood counts and how the person is doing.
An empty marrow
The report describes very few cells and no clear leukaemia. This is what the team hopes to see. The plan is usually to support the person through the low counts and wait for the marrow to refill.
Leukaemia cells still present
Blasts, the immature leukaemia cells, are still clearly visible. The team may plan a second round of induction without waiting for full recovery, or change the treatment.
Often considered next
- A second induction course
- A different drug combination
- Early referral for transplant assessment
Unclear
Sometimes the sample is too thin to read, or a few odd cells could be leukaemia or early recovery. The team may repeat the marrow a week or so later rather than guess.
An unclear result is common and is not a bad result.On your report
What do the words on the marrow report mean?
- Hypocellular
- The marrow has far fewer cells than normal. After induction, this is expected.
- Aplastic or empty marrow
- Almost no blood-making cells are left. At Day 14 this usually means the chemotherapy has done its job.
- Blasts
- Young, immature cells. In AML, most leukaemia cells are blasts, so the report counts them as a percentage of all cells.
- Residual disease
- Leukaemia is still present after treatment. The report may describe how much.
- Aspirate and trephine
- The aspirate is the liquid sample. The trephine is the small core of bone. Each shows something slightly different.
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After the result
What happens between Day 14 and remission?
If the marrow is empty, the next weeks are about keeping the person safe while it refills. Blood counts are checked often. Transfusions of red cells and platelets are given when the team decides they are needed. Infection is the main danger during this stretch.
The recovery marrow
Once the white cells and platelets start to rise, a second marrow is usually taken. This one checks for remission, which means no leukaemia can be seen under the microscope and the blood counts have recovered. Many teams describe remission as fewer than 5% blasts in the marrow, along with recovering counts.
Deeper tests on the same sample
The recovery sample is often also sent for measurable residual disease testing. This looks for tiny amounts of leukaemia that a microscope cannot see. It helps decide what comes after induction, including whether a transplant should be discussed.
Blood count ranges and report wording differ between laboratories. A single result is always read alongside symptoms and repeat tests.Commonly believed
What do families often get wrong about this test?
"An empty marrow means the leukaemia is gone."
Not yet. An empty marrow at Day 14 is an encouraging early sign, but remission is only confirmed once the counts recover and the marrow is checked again. Treatment continues after that too.
"If leukaemia is still there, treatment has failed."
Some people need two rounds of induction to reach remission. Finding leukaemia at Day 14 changes the plan. It does not mean there is nothing more to try.
"The marrow test will make the counts drop further."
The sample is tiny compared with the whole marrow. The low counts come from the chemotherapy, not from the test. Skipping the test only means the team has less to go on.
"We should refuse it because he is too weak."
Weakness is common at this stage and the test is short. If you are worried, ask what the result will change. Your haematologist will explain whether it is worth doing for this person now.
Did you know
At CION, the haematology team reviews marrow results alongside the blood counts and genetic tests, and complex cases go to a tumour board. Where a transplant or specialist test is needed, the team coordinates with qualified centres and tells you what to ask them.
Questions we are asked
Common questions about the Day 14 marrow
Does the Day 14 bone marrow test hurt?
The skin is numbed first, so the needle going in feels like pressure. Drawing out the liquid marrow causes a sharp, deep ache for a few seconds. Most people describe it as uncomfortable rather than unbearable. Ask for a mild sedative if the person is very anxious. The site may feel bruised for a few days.
How long does the result take?
A first look under the microscope is often available within a day or two. Extra tests on the same sample, such as flow cytometry or genetic studies, take longer. The team may give you the early picture first and confirm it later. Ask the ward doctor when they expect to discuss it with you.
Is the test done on exactly the fourteenth day?
Not always. "Day 14" is a label for roughly two weeks after the start of induction. The test may be done a day or two either side, depending on the schedule, weekends and how the person is. A small shift in timing does not change what the result means.
Why is my father being given platelets before the test?
Chemotherapy pushes platelets very low, and platelets help blood to clot. A transfusion before the needle goes in lowers the chance of bleeding at the site. The team decides this from the morning blood count. It is a routine safety step, not a sign that something has gone wrong.
What if there are still leukaemia cells?
The team will usually discuss a second round of induction or a different combination of medicines. They look at the genetic results, how the person coped with the first round and their general health. This is also often the point where transplant assessment is raised. Ask what the options are and what each one involves.
Does an empty marrow mean we can go home?
Usually not straight away. With an empty marrow, blood counts stay very low until recovery begins, and infections can become serious quickly. Most people stay under close watch until the white cells begin to rise. The team will tell you when it is safe to plan discharge.
Can the Day 14 result tell us the outlook?
Only partly. It shows how the leukaemia reacted to the first round, which is one piece of the picture. The genetic type of AML, age, general health and later test results matter as much. Your haematologist can explain what the result means for this person, which a general page cannot.
Can we get a second opinion on the marrow report?
Yes. The slides and report can be reviewed by another haematologist or pathologist. Ask the treating team for copies of every marrow report and the blood counts. A second opinion should not delay treatment decisions that cannot wait, so talk to the treating team about timing first.
Your Haematologist
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Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Sources
- Cancer Research UK — Treatment for acute myeloid leukaemia (AML)
- National Cancer Institute — Adult Acute Myeloid Leukemia Treatment (PDQ) - Patient Version
- American Cancer Society — Acute Myeloid Leukemia (AML)
- Leukemia & Lymphoma Society — Acute Myeloid Leukemia
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Induction Chemotherapy for AML: The First 30 DaysThe treatment this marrow test is checkingInfection Risk During AML InductionThe main danger while the marrow is emptyConsolidation After AML RemissionWhat usually comes after remission is confirmedWhen AML Needs a TransplantWhen the marrow result leads to a transplant discussion
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