Peripheral blood blast clearance is an independent prognostic factor for survival and response to acute myeloid leukemia induction chemotherapy

Abstract

In patients with acute myeloid leukemia (AML), rapid reduction of circulating blasts with induction chemotherapy may serve as an in vivo marker of chemosensitivity. We performed a retrospective analysis of 363 patients with untreated AML who received induction chemotherapy in order to determine the relationship between day of blast disappearance (DOBD) and complete remission (CR) rates, event-free survival (EFS), and overall survival (OS). DOBD ≤5 vs. >5 was identified as the most discriminating cutoff for OS. DOBD >5 was observed in 35 patients (9.6%). The CR rate for patients with DOBD ≤5 vs. >5 was 74.0% and 28.6%, median EFS was 9.4 months and 1.8 months, and median OS was 17.1 months and 5.8 months, respectively (P<0.001 for all). DOBD >5 was independently associated with a lower CR rate and shorter EFS and OS (P<0.001 for all). DOBD >5 retained prognostic significance for EFS and OS when patients were stratified by cytogenetic risk group, de novo vs. secondary or therapy-related AML, European LeukemiaNet-based risk groups, and whether CR was achieved. We propose DOBD >5 as a simple and early marker of disease resistance that identifies patients with poor prognosis who otherwise may not be identified with existing risk stratification systems.

Bone marrow blast elimination by the fifth day of 7 + 3 induction is the strongest predictor of potential cure in patients with acute myeloid leukemia younger than 61 years of age: A long‐term follow‐up of a multi‐center prospective study

“…Rapid eradication of blasts from the peripheral blood during induction therapy for AML is associated with a good response to initial treatment . Our previously conducted prospective observational study has aimed to identify the subgroup of leukemic patients in whom a prompt response to therapy would be a surrogate for a superior outcome.…”

Peripheral blood blast rate of clearance is an independent predictor of clinical response and outcomes in acute myeloid leukaemia

“…Several previous studies have determined that favourable treatment outcomes are associated with early PBB clearance by a specific day, i.e. within day 5, 6, or 7 of treatment initiation (Elliott et al , ; Lacombe et al , ; Arellano et al , ; Gao et al , ; Short et al , ), and some have accordingly proposed new risk‐adapted stratification systems (Long, ). However, in our current study, we found that not only the day of clearance, but also the rate of clearance is associated with achievement of CR and improved OS in AML.…”

“…Factors significantly associated with OS in our patient cohort included a favourable‐ or intermediate‐risk ELN risk category, SCT status and cytoreduction with hydroxycarbamide (Table ). Several previous studies exploring PBB clearance as a prognostic factor in AML (Arellano et al , ; Short et al , ) did not include data in their analysis or discussion regarding the use of pre‐chemotherapy cytoreductive therapies, which is an important and potentially confounding factor to consider, and which is also immediately relevant to current clinical practice. Approximately one‐third of our patient cohort required cytoreduction with hydroxycarbamide prior to initiation of induction chemotherapy, which was interestingly associated with improvement in OS.…”

Comprehensive analysis for cellular senescence-related immunogenic characteristics and immunotherapy prediction of acute myeloid leukemia

“…To investigate the independence of the signature in prediction, we carried out univariate and multivariate Cox analyses for the variables in clinic and SRGS in the TCGA-AML set. The chosen clinical variables mainly included gender, peripheral blood (PB) blasts percent (PB-blast), bone marrow (BM) blast percent (BM_blast), hemoglobin, white blood cell (WBC), and platelets levels, all of which have been found important for the prognosis of AML patients ( McQuilten et al, 2022 ; Acharya et al, 2018 ; Just et al, 2019 ; Liu et al, 2019 ; Ogawa et al, 2018 ; Short et al, 2016 ; Ustun et al, 2021 ).…”