title: Routine interim disease assessment in patients undergoing induction chemotherapy for acute myeloid leukemia: Can we do better?
abstract: The presence of >5% blasts at "day 14" (D14), in patients undergoing induction chemotherapy for acute myeloid leukemia (AML) is problematic. It is unclear if a second course of chemotherapy for early persistent disease will alter outcome in these patients. We conducted a retrospective study of AML patients undergoing induction chemotherapy where diagnostic, interim (around day 14), and recovery (days 21-42) bone marrow (BM) evaluations were available for review. Of the 113 patients included in the final analysis, 99 (87.6%) achieved CR at hematologic recovery. At D14, 90 patients (79.6%) had <5% blasts and of these, 87 (96.7%) ultimately achieved CR. At D14, Twenty-three (20.4%) patients had residual leukemia (>5% blasts). Of these, 11 (47.8%) received a second course of chemotherapy (double induction [DI]) and 12 (52.2%) were observed until count recovery (single induction [SI]). No significant difference in CR rates was observed between these two groups (58.3% DI group vs. 45.5% SI group, P value = 0.684). In our analysis, D14 BM evaluation did not uniformly identify patients with primary induction failure. To unequivocally determine the value of a D14 marrow assessment in AML, prospective studies in the context of large cooperative group trials are required. Considering our findings and similar reports from others, we propose that D14 marrow assessment should be individualized, and that other factors, such as cytogenetics and early peripheral blood blast clearance should be considered, to identify patients most likely to benefit from interim disease assessment during AML induction therapy.
authors.affiliation: Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of Miami and Sylvester Comprehensive Cancer Center, and Jackson Memorial Hospital, Miami, Florida.
authors.forename: Germán
authors.initials: G
authors.lastname: Campuzano-Zuluaga
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of Miami and Sylvester Comprehensive Cancer Center, and Jackson Memorial Hospital, Miami, Florida.
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Deutsch
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of Miami and Sylvester Comprehensive Cancer Center, and Jackson Memorial Hospital, Miami, Florida.
authors.forename: Matthew
authors.initials: M
authors.lastname: Salzberg
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of Miami and Sylvester Comprehensive Cancer Center, and Jackson Memorial Hospital, Miami, Florida.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gomez
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of Miami and Sylvester Comprehensive Cancer Center, and Jackson Memorial Hospital, Miami, Florida.
authors.forename: Fernando
authors.initials: F
authors.lastname: Vargas
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of Miami and Sylvester Comprehensive Cancer Center, and Jackson Memorial Hospital, Miami, Florida.
authors.forename: Roy
authors.initials: R
authors.lastname: Elias
authors.affiliation: Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida.
authors.forename: Deukwoo
authors.initials: D
authors.lastname: Kwon
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of Miami and Sylvester Comprehensive Cancer Center, and Jackson Memorial Hospital, Miami, Florida.
authors.forename: Mark
authors.initials: M
authors.lastname: Goodman
authors.affiliation: Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of Miami and Sylvester Comprehensive Cancer Center, and Jackson Memorial Hospital, Miami, Florida.
authors.forename: Offiong F
authors.initials: OF
authors.lastname: Ikpatt
authors.affiliation: Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of Miami and Sylvester Comprehensive Cancer Center, and Jackson Memorial Hospital, Miami, Florida.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Chapman
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of Miami and Sylvester Comprehensive Cancer Center, and Jackson Memorial Hospital, Miami, Florida.
authors.forename: Justin
authors.initials: J
authors.lastname: Watts
authors.affiliation: Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of Miami and Sylvester Comprehensive Cancer Center, and Jackson Memorial Hospital, Miami, Florida.
authors.forename: Francisco
authors.initials: F
authors.lastname: Vega
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of Miami and Sylvester Comprehensive Cancer Center, and Jackson Memorial Hospital, Miami, Florida.
authors.forename: Ronan
authors.initials: R
authors.lastname: Swords
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001853:Bone Marrow / Q000473:pathology; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods*; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult