title: Evaluation of bone marrow aspirates in patients with acute myeloid leukemia at day 14 of induction therapy.
abstract: BACKGROUND
  Early assessment of response to chemotherapy in acute myeloid leukemia may be performed by examining bone marrow aspirate (BMA) or biopsy (BMB); a hypocellular bone marrow sample indicates adequate anti-leukemic activity. We sought to evaluate the quantitative and qualitative assessment of BMA performed on day 14 (D14) of chemotherapy, to verify the inter-observer agreement, to compare the results of BMA and BMB, and to evaluate the impact of D14 blast clearance on the overall survival (OS).
  
  
  METHODS
  A total of 107 patients who received standard induction chemotherapy and had bone marrow samples were included. BMA evaluation was performed by two observers using two methods: quantitative assessment and a qualitative (Likert) scale. ROC curves were obtained correlating the BMA quantification of blasts and the qualitative scale, by both observers, with BMB result as gold-standard.
  
  
  RESULTS
  There was a significant agreement between the two observers in both the qualitative and quantitative assessments (Kw = 0.737, p < 0.001, and rs = 0.798, p < 0.001; ICC = 0.836, p < 0.001, respectively). The areas under the curve (AUC) were 0.924 and 0.946 for observer 1 and 0.867 and 0.870 for observer 2 for assessments of the percentage of blasts and qualitative scale, respectively. The best cutoff for blast percentage in BMA was 6% and 7% for observers 1 and 2, respectively. A similar analysis for the qualitative scale showed the best cutoff as "probably infiltrated". Patients who attained higher grades of cytoreduction on D14 had better OS.
  
  
  CONCLUSIONS
  Evaluation of D14 BMA using both methods had a significant agreement with BMB and between observers, identifying a population of patients with poor outcome.
authors.affiliation: University Hospital, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 255, Sala 4A 12, Rio de Janeiro, 22251-030, RJ, Brazil. drjoaotadeu@yahoo.com.br.|Faculdade de Medicina de Campos, Campos dos Goytacazes, RJ, Brazil. drjoaotadeu@yahoo.com.br.|Instituto Federal de Educação, Ciência e Tecnologia Fluminense, Campos dos Goytacazes, RJ, Brazil. drjoaotadeu@yahoo.com.br.
authors.forename: João Tadeu D
authors.initials: JT
authors.lastname: Souto Filho
authors.affiliation: University Hospital, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 255, Sala 4A 12, Rio de Janeiro, 22251-030, RJ, Brazil. morgadoloureiro@gmail.com.
authors.forename: Monique M
authors.initials: MM
authors.lastname: Loureiro
authors.affiliation: University Hospital, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 255, Sala 4A 12, Rio de Janeiro, 22251-030, RJ, Brazil.
authors.forename: Wolmar
authors.initials: W
authors.lastname: Pulcheri
authors.affiliation: University Hospital, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 255, Sala 4A 12, Rio de Janeiro, 22251-030, RJ, Brazil.
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Morais
authors.affiliation: University Hospital, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 255, Sala 4A 12, Rio de Janeiro, 22251-030, RJ, Brazil. mnucci@hucff.ufrj.br.
authors.forename: Marcio
authors.initials: M
authors.lastname: Nucci
authors.affiliation: University Hospital, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 255, Sala 4A 12, Rio de Janeiro, 22251-030, RJ, Brazil. doyle66@gmail.com.
authors.forename: Rodrigo D
authors.initials: RD
authors.lastname: Portugal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D019540:Area Under Curve; D001707:Biopsy, Needle; D001853:Bone Marrow / Q000187:drug effects / Q000473:pathology*; D002648:Child; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D053208:Kaplan-Meier Estimate; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D055815:Young Adult