title: Prospective comparison of early bone marrow evaluation on day 5 versus day 14 of the "3 + 7" induction regimen for acute myeloid leukemia.
abstract: Evaluation of early response during induction therapy for acute myeloid leukemia (AML) is used for prognostication and re-induction strategy, yet the optimal evaluation time point is unknown. Clearance of bone marrow (BM) blasts by day 14 of therapy does not ensure remission; thus, some patients requiring re-induction are neglected. This study aimed to examine the role of earlier BM evaluation during induction for predicting remission and overall survival. Results of BM testing on the 5th and 14th day of intensive induction were prospectively compared in 127 adult patients with AML. Re-induction was given, based on Day 14 results, to 25 patients. Reduction of the BM blast count to <5% as early as by the fifth day of induction was more specifically associated with the achievement of remission compared to Day 14 (88.2% vs. 60%, respectively). Rapid responders have a better 3-year overall survival (OS). Day 5 results are a stronger predictor of OS by multivariate analysis and better segregate long-term survivors than the Day 14th BM count (66% vs. 30%, P = 0.0001 and 48% vs. 37%, respectively, P = 0.04). The Day 5 evaluation of BM carries significant clinical information. The benefit of prescribing re-induction based on such early evaluation should be prospectively studied.
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.|Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel, Israel Institute of Technology.
authors.forename: Yishai
authors.initials: Y
authors.lastname: Ofran
authors.affiliation: Quality of Care Unit, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Ronit
authors.initials: R
authors.lastname: Leiba
authors.affiliation: Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Chezi
authors.initials: C
authors.lastname: Ganzel
authors.affiliation: Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Revital
authors.initials: R
authors.lastname: Saban
authors.affiliation: Hematology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Moshe
authors.initials: M
authors.lastname: Gatt
authors.affiliation: Department of Hematology and bone marrow transplantation, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Ram
authors.affiliation: Department of Hematology, Sanz Medical Center - Laniado Hospital, Netanya, Israel.
authors.forename: Ariela
authors.initials: A
authors.lastname: Arad
authors.affiliation: Department of Hematology, Sanz Medical Center - Laniado Hospital, Netanya, Israel.
authors.forename: Shlomo
authors.initials: S
authors.lastname: Bulvik
authors.affiliation: Hematology department, Meir Medical Center, Kfar Saba, Israel.
authors.forename: Ilana
authors.initials: I
authors.lastname: Hellmann
authors.affiliation: Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel.
authors.forename: Sharon
authors.initials: S
authors.lastname: Gino-Moor
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.|Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel, Israel Institute of Technology.
authors.forename: Tsila
authors.initials: T
authors.lastname: Zuckerman
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.|Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel, Israel Institute of Technology.
authors.forename: Ron
authors.initials: R
authors.lastname: Hoffman
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.|Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel, Israel Institute of Technology.
authors.forename: Netanel
authors.initials: N
authors.lastname: Horowitz
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.|Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel, Israel Institute of Technology.
authors.forename: Noa
authors.initials: N
authors.lastname: Lavi
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.|Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel, Israel Institute of Technology.
authors.forename: Shimrit
authors.initials: S
authors.lastname: Ringelstein
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Israel
authors.initials: I
authors.lastname: Henig
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Hayun
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.|Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel, Israel Institute of Technology.|Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Rowe
mesh_terms: D001853:Bone Marrow / Q000378:metabolism* / Q000473:pathology; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012074:Remission Induction; D016896:Treatment Outcome