Leukocyte count as a predictor of death during remission induction in acute myeloid leukemia.
Acute myeloid leukemia (AML) presenting with a high leukocyte count has been associated with an increase in induction mortality and poor results in a number of other survival measures. However, the level at which an elevated leukocyte count has prognostic significance in AML remains unclear. In this report on a series of 375 adult (non-M3) AML patients undergoing induction chemotherapy at a single institution, leukocyte count analyzed as a continuous variable is shown to be a better predictor of induction death (ID) and overall survival (OS) than a leukocyte count of > or = 100 x 10(9)/L, a value characteristically associated with "hyperleukocytosis" (HL). In this patient cohort, a presenting leukocyte count of > or = 30 x 10(9)/L had high sensitivity and specificity for predicting ID, and both performance status (PS) and leukocyte count more accurately predicted for ID than age. Considering these parameters in newly-diagnosed AML patients may facilitate the development of strategies for reducing induction mortality.
Greenwood
M J
MJ
The Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology and Hematopathology, Vancouver General Hospital, BC Cancer Agency and the University of British Columbia, Vancouver, BC, Canada.
Seftel
M D
MD
Richardson
C
C
Barbaric
D
D
Barnett
M J
MJ
Bruyere
H
H
Forrest
D L
DL
Horsman
D E
DE
Smith
C
C
Song
K
K
Sutherland
H J
HJ
Toze
C L
CL
Nevill
T J
TJ
Nantel
S H
SH
Hogge
D E
DE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001853:Bone Marrow / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality*; D007958:Leukocyte Count; D007962:Leukocytes / Q000166:cytology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012372:ROC Curve; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome
D000970:Antineoplastic Agents