Early clearance of peripheral blood blasts predicts response to induction chemotherapy in acute myeloid leukemia

BACKGROUND: Early marrow blast clearance 14 days after induction chemotherapy is an independent prognostic indicator of outcomes in acute myeloid leukemia (AML). METHODS: We evaluated the relationship between time to peripheral blood blast clearance after induction and disease status as assessed by...

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Published in:Cancer 2012-11, Vol.118 (21), p.5278-5282
Main Authors: Arellano, Martha, Pakkala, Suchita, Langston, Amelia, Tighiouart, Mourad, Pan, Lin, Chen, Zhengjia, Heffner, Leonard T., Lonial, Sagar, Winton, Elliott, Khoury, H. Jean
Format: Article
Language:English
Subjects:
acute myeloid leukemia
Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Biological and medical sciences
blood blasts
clearance
Female
Granulocyte Precursor Cells - drug effects
Hematologic and hematopoietic diseases
Humans
Induction Chemotherapy
Leukemia, Myeloid, Acute - blood
Leukemia, Myeloid, Acute - drug therapy
Leukemia, Myeloid, Acute - pathology
Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis
Male
Medical sciences
Middle Aged
outcomes
remission
Remission Induction
Survival Rate
Time Factors
Tumors
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Summary:BACKGROUND: Early marrow blast clearance 14 days after induction chemotherapy is an independent prognostic indicator of outcomes in acute myeloid leukemia (AML). METHODS: We evaluated the relationship between time to peripheral blood blast clearance after induction and disease status as assessed by day 14 and day 30 marrow biopsies in 162 patients with AML. Day 6 after induction was the optimal cutoff point determined by a receiver operating characteristic analysis and was selected to divide patients into early blast clearance (EBC; ≤6 days; n = 119) and delayed blast clearance (DBC; >6 days; n = 43) groups. RESULTS: DBC patients were older, but otherwise the 2 groups were comparable. Marrow blast clearance on day 14 after induction chemotherapy was observed in 84% of patients in the EBC group and 60% in the DBC group. With a median follow‐up of 1538 days, both relapse‐free survival (RFS) (442 vs 202 days, P = .0017) and overall survival (OS) (930 vs 429 days, P < .0001) were longer in the EBC group, and a multivariable analysis showed that EBC independently predicted clearance of marrow blasts at day 14 (P = .0018), remission (P = .0179), RFS (P = .0171), and OS (P = .0122). CONCLUSIONS: Early clearance of peripheral blood blasts after induction chemotherapy predicts for early marrow blast clearance, complete remission, RFS, and OS. Cancer 2012. © 2012 American Cancer Society. Early blast clearance measured on daily complete blood counts is a strong predictor of remission, and relapse‐free and overall survival in newly diagnosed acute myeloid leukemia. Measurement of peripheral blood blasts can be an encouraging early measure of treatment response in patients with newly diagnosed acute myeloid leukemia who are undergoing induction chemotherapy.
ISSN:0008-543X
1097-0142
DOI:10.1002/cncr.27494