The percentage of peripheral blood blasts on day 7 of induction chemotherapy predicts response to therapy and survival in patients with acute myeloid leukemia.
BACKGROUND
Rapid clearance of peripheral blood blasts (PBBs) predicts complete remission (CR) and survival in patients with acute myeloid leukemia (AML). We aimed to explore the correlation between induction therapy response, outcome, and the PBB percentage.


METHODS
Forty-six consecutive patients with de novo AML (excluding acute promyelocytic leukemia) were enrolled in this study. Flow cytometry was performed to identify cells with a leukemia-associated aberrant immunophenotype in the initial bone marrow aspirate and in peripheral blood on day 7 of induction therapy.


RESULTS
The PBB percentage on day 7 (D7PBBP) was significantly lower in patients who achieved CR (0.03% (0.0%, 0.45%)) than in those who did not (10.85% (1.13%, 19.38%); u = -3.92, P < 0.001). The CR rate was significantly higher among patients with a D7PBBP of <0.945% (84.62%, 22/26) than among those with a D7PBBP of = 0.945% (25.0%, 5/20; χ2 = 16.571, P < 0.001). D7PBBP was significantly correlated with overall survival (OS; r = -0.437, P = 0.003) and relapsefree survival (RFS; r = -0.388, P = 0.007). OS and RFS were significantly higher in patients with a D7PBBP of <0.43% than in those with a D7PBBP of ≥ 0.43% (P < 0.001 and P = 0.039, respectively). D7PBBP was also found to be an independent prognostic indicator in multivariate analysis for both OS (P = 0.036) and RFS (P = 0.035).


CONCLUSIONS
D7PBBP may be an important risk factor for the achievement of complete remission, for overall survival, and for relapse-free survival.
Department of Hematology and Oncology, First Hospital, Bethune Medical College, Jilin University, Changchun, Jilin 130021, China. Email: gaosujunjdyy@163.com.
Sujun
S
Gao
Department of Hematology and Oncology, First Hospital, Bethune Medical College, Jilin University, Changchun, Jilin 130021, China.
Yehui
Y
Tan
Department of Hematology and Oncology, First Hospital, Bethune Medical College, Jilin University, Changchun, Jilin 130021, China.
Xiaoliang
X
Liu
Department of Hematology and Oncology, First Hospital, Bethune Medical College, Jilin University, Changchun, Jilin 130021, China.
Long
L
Su
Department of Hematology and Oncology, First Hospital, Bethune Medical College, Jilin University, Changchun, Jilin 130021, China.
Ping
P
Yu
Department of Hematology and Oncology, First Hospital, Bethune Medical College, Jilin University, Changchun, Jilin 130021, China.
Wei
W
Han
Department of Hematology and Oncology, First Hospital, Bethune Medical College, Jilin University, Changchun, Jilin 130021, China.
Jiuwei
J
Cui
Department of Hematology and Oncology, First Hospital, Bethune Medical College, Jilin University, Changchun, Jilin 130021, China.
Wei
W
Li
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents; D000971:Antineoplastic Combined Chemotherapy Protocols; D001752:Blast Crisis / Q000150:complications / Q000188:drug therapy; D002648:Child; D003561:Cytarabine / Q000627:therapeutic use; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D015255:Idarubicin / Q000627:therapeutic use; D016130:Immunophenotyping; D060828:Induction Chemotherapy; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D055815:Young Adult
D000970:Antineoplastic Agents; D003561:Cytarabine; D015255:Idarubicin