title: Leukocyte count as a predictor of death during remission induction in acute myeloid leukemia.
abstract: 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.
authors.affiliation: 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.
authors.forename: M J
authors.initials: MJ
authors.lastname: Greenwood
authors.forename: M D
authors.initials: MD
authors.lastname: Seftel
authors.forename: C
authors.initials: C
authors.lastname: Richardson
authors.forename: D
authors.initials: D
authors.lastname: Barbaric
authors.forename: M J
authors.initials: MJ
authors.lastname: Barnett
authors.forename: H
authors.initials: H
authors.lastname: Bruyere
authors.forename: D L
authors.initials: DL
authors.lastname: Forrest
authors.forename: D E
authors.initials: DE
authors.lastname: Horsman
authors.forename: C
authors.initials: C
authors.lastname: Smith
authors.forename: K
authors.initials: K
authors.lastname: Song
authors.forename: H J
authors.initials: HJ
authors.lastname: Sutherland
authors.forename: C L
authors.initials: CL
authors.lastname: Toze
authors.forename: T J
authors.initials: TJ
authors.lastname: Nevill
authors.forename: S H
authors.initials: SH
authors.lastname: Nantel
authors.forename: D E
authors.initials: DE
authors.lastname: Hogge
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents