Predictors for requiring re-induction chemotherapy in acute myeloid leukemia patients with residual disease on day 14 bone marrow assessment. (December 2017)

• Record Type: Journal Article
• Authors: Nachar, Victoria R.; Perissinotti, Anthony J.; Scappaticci, Gianni B.; Bixby, Dale L.; Marini, Bernard L.
• Is Part Of: Leukemia research. Volume 63(2017:Dec.)
• Page Start: 56
• Page End: 61
• Publication Date: 2017-12
• Subjects: AML -- Day 14 -- Bone marrow biopsy -- Complete remission -- Prognostic factors; Leukemia -- Periodicals; Leukemia -- Periodicals; Leucémie -- Périodiques; Leukemia; Periodicals; Electronic journals; Electronic journals; 616.9941905
• DOI: 10.1016/j.leukres.2017.10.017
• Languages: English
• ISSNs: 0145-2126

Abstract

Highlights: The utility of day 14 BM biopsies following 3 + 7 induction is controversial. 50% of patients with positive day 14 BM biopsies achieve CR/CRi without reinduction. Favorable risk cytogenetics is significant for attaining CR/CRi at repeat BM biopsy. Abstract: Purpose: Day 14 bone marrow (BM) biopsies following standard induction in acute myeloid leukemia (AML) have a suboptimal ability to predict complete remission (CR). The decision to administer re-induction chemotherapy with residual disease on day 14 is variable and lacks clear guidance. Methods: We retrospectively compared clinical and laboratory characteristics of adult patients with newly diagnosed, previously untreated AML who underwent 3 + 7 induction chemotherapy from January 2004 until February 2017. Results: Of 90 patients with a positive day 14 BM biopsy, 53 did not receive immediate re-induction chemotherapy. Twenty-seven (51%) of those patients achieved a CR upon count recovery. Favorable risk cytogenetics was found to be highly significant for attaining a CR at repeat BM biopsy. Conclusions: Day 14 BM evaluations following 3 + 7 induction are unable to accurately predict the ability to achieve a CR. Many patients will attain a CR despite no further chemotherapy. The decision to re-induce can be safely delayed in many patients, especially those with favorable risk cytogenetics.