title: Prognostic value of complete remission with superior platelet counts in acute myeloid leukemia.
abstract: BACKGROUND
  Complete remission (CR) in acute myeloid leukemia (AML) is defined as having ≤5% leukemic blast cells in the bone marrow and return of normal hematopoiesis after the first induction cycle. There is a subset of patients, however, who achieve reduction of leukemic blast cells with a subnormal platelet count, designated as CR with incomplete platelet recovery (platelet count, ≤100,000/mcL; normal, 150,000-450,000/mcL), which is associated with inferior outcomes when compared with CR. Furthermore, there is another subset of patients with CR but superior platelet counts (≥400,000/mcL) whose prognostic significance is unclear.
  
  
  OBJECTIVE
  To establish whether CR with superior platelet counts is associated with better outcomes and can be used as a separate entity for prognostication.
  
  
  METHODS
  A retrospective chart review of 104 cases of AML was conducted. The highest platelet count during days 25-35 from initiation of induction chemotherapy (designated as day 30 platelet count) was documented. A multivariate analysis for other factors such as age, sex, risk categories, day 14+ plasma cell count (average plasma cell percentage at days 14-21), infections, allogeneic bone marrow transplant, and remission status was done.
  
  
  RESULTS
  Day 30 platelet count was found to be an independent predictor of survival in AML. On the multivariate analysis, the subgroup with superior platelet counts (≥400,000/mcL) was found to be associated with better outcomes.
  
  
  CONCLUSIONS
  Results need to be validated in a larger cohort.
  
  
  CONCLUSIONS
  CR with superior platelet recovery (≥400,000/mcL) is a unique subcategory in itself and has prognostic significance. This may help better assess response to chemotherapeutic agents and aid in further decision-making regarding treatment.
authors.affiliation: Department of Internal Medicine, Medical College of Georgia, Augusta, Georgia, USA. amangaonkar@gru.edu.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Mangaonkar
authors.affiliation: Department of Biostatistics, Medical College of Georgia, Augusta, Georgia, USA.
authors.forename: Hongyan
authors.initials: H
authors.lastname: Xu
authors.affiliation: Department of Internal Medicine, Medical College of Georgia, Augusta, Georgia, USA.
authors.forename: Jamal
authors.initials: J
authors.lastname: Mohsin
authors.affiliation: Department of Internal Medicine, Medical College of Georgia, Augusta, Georgia, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Mansour
authors.affiliation: Department of Internal Medicine, Medical College of Georgia, Augusta, Georgia, USA.
authors.forename: Rohini
authors.initials: R
authors.lastname: Chintalapally
authors.affiliation: Department of Internal Medicine, Medical College of Georgia, Augusta, Georgia, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Keen
authors.affiliation: Department of Pathology, Medical College of Georgia, Augusta, Georgia, USA.
authors.forename: Ashis K
authors.initials: AK
authors.lastname: Mondal
authors.affiliation: Department of Pharmacy, Medical College of Georgia, Augusta, Georgia, USA.|Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, Georgia, USA.
authors.forename: David
authors.initials: D
authors.lastname: DeRemer
authors.affiliation: Department of Pharmacy, Medical College of Georgia, Augusta, Georgia, USA.|Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, Georgia, USA.
authors.forename: Amber B
authors.initials: AB
authors.lastname: Clemmons
authors.affiliation: Department of Pharmacy, Medical College of Georgia, Augusta, Georgia, USA.|Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, Georgia, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Clark
authors.affiliation: Department of Pharmacy, Medical College of Georgia, Augusta, Georgia, USA.|Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, Georgia, USA.
authors.forename: Arpita
authors.initials: A
authors.lastname: Shah
authors.affiliation: Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
authors.forename: Anand
authors.initials: A
authors.lastname: Jillela
authors.affiliation: Department of Pathology, Medical College of Georgia, Augusta, Georgia, USA.
authors.forename: Ravindra
authors.initials: R
authors.lastname: Kolhe
authors.affiliation: Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
authors.forename: Vamsi
authors.initials: V
authors.lastname: Kota
keywords: acute myeloid leukemia; complete remission; day 30 platelet count; survival