Prospective comparison of early bone marrow evaluation on day 5 versus day 14 of the “3 + 7” induction regimen for acute myeloid leukemia

Abstract

Evaluation of early response during induction therapy for acute myeloid leukemia (AML) is used for prognostication and re-induction strategy, yet the optimal evaluation time point is unknown. Clearance of bone marrow (BM) blasts by day 14 of therapy does not ensure remission; thus, some patients requiring re-induction are neglected. This study aimed to examine the role of earlier BM evaluation during induction for predicting remission and overall survival. Results of BM testing on the 5th and 14th day of intensive induction were prospectively compared in 127 adult patients with AML. Re-induction was given, based on Day 14 results, to 25 patients. Reduction of the BM blast count to <5% as early as by the fifth day of induction was more specifically associated with the achievement of remission compared to Day 14 (88.2% vs. 60%, respectively). Rapid responders have a better 3-year overall survival (OS). Day 5 results are a stronger predictor of OS by multivariate analysis and better segregate long-term survivors than the Day 14th BM count (66% vs. 30%, P 5 0.0001 and 48% vs. 37%, respectively, P 5 0.04). The Day 5 evaluation of BM carries significant clinical information. The benefit of prescribing re-induction based on such early evaluation should be prospectively studied.

Serum Flt3 ligand is biomarker of progenitor cell mass and prognosis in acute myeloid leukemia

“…Treatment refractoriness is difficult to predict from clinical, cytogenetic and molecular genetic information 3,4 . An interim bone marrow assessment at day 15 may discern blast clearance and is routine practice in many North American centers 33 . However, this is often a nadir for the patient in terms of cytopenia and attendant systemic illness and interpretation can be difficult.…”

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

“…Patient median age was 58 (range 22‐78) years. Patient characteristics were previously described . The majority of patients had de novo AML [75/109 (69%)] of standard or intermediate risk [72/109 (66%)].…”

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

“…Higher percentages of residual blasts on interim BM evaluation (generally performed at Days 14–16) are associated with lower rates of CR, increased rates of relapse, and shorter OS . The presence of ≥5% BM blasts as early as Day 5 or 6 of induction may also be predictive for significantly lower CR rates and shorter OS . Several small studies have also evaluated the prognostic impact of various measures of PB blast dynamics, all of which have the added benefit of being significantly less invasive than BM analysis.…”