title: [The prognostic significance of proportion of blasts in bone marrow on day 14 during induction chemotherapy in patients with adult Ph-negative acute lymphoblastic leukemia].
abstract: OBJECTIVE
  To investigate the prognostic significance of proportion of the blasts in bone marrow on day 14 (D14) during induction chemotherapy in patients with adult Ph-negative acute lymphoblastic leukemia (Ph (-) ALL).
  
  
  METHODS
  Newly diagnosed Ph (-) ALL patients with bone marrow morphology analysis on day 14 during induction chemotherapy were analyzed retrospectively. The proportion of the D14 blasts which had an impact on achieving a CR by the first induction chemotherapy and outcomes were determined by ROC curve.
  
  
  RESULTS
  166 ALL patients including 94 male and 72 female were analyzed. The median age was 32 years (range, 18-64 years). The CR rate by the first induction chemotherapy was 74.7% with a total CR rate as 93.3%. By ROC analysis, 7.5% of the D14 blasts had the best sensitivity and specificity. The patients with D14 blasts ≥7.5% had lower CR rates after the first and overall induction chemotherapy compared with those with D14 blasts <7.5% (42.7% vs 85.9%, P<0.001 and 75.9% vs 95.6%, P=0.001 respectively). The probabilities of 5-year disease free survival (DFS) and 5-year overall survival (OS) were higher in the patients with D14 blasts<7.5% than those with D14 blasts ≥7.5% (49.8% vs 29.6%, P=0.006 and 52.4% vs 32.6%, P=0.010 respectively). Multivariate analysis showed that higher WBC or central nervous system leukemia at diagnosis, D14 blasts ≥7.5%, no CR after the first induction chemotherapy and receiving consolidation and maintenance chemotherapy rather than transplant were associated with poor outcomes.
  
  
  CONCLUSIONS
  Higher proportion of D14 blasts in bone marrow during the first induction therapy indicated poor prognosis in adult Ph(-) ALL.
authors.affiliation: Peking University People's Hospital, Peking University Institute of Hematology 100044 Beijing, China.
authors.forename: J S
authors.initials: JS
authors.lastname: Jia
authors.forename: S M
authors.initials: SM
authors.lastname: Yang
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.forename: H
authors.initials: H
authors.lastname: Jiang
authors.forename: T
authors.initials: T
authors.lastname: Zhao
authors.forename: L
authors.initials: L
authors.lastname: Bao
authors.forename: H X
authors.initials: HX
authors.lastname: Shi
authors.forename: J
authors.initials: J
authors.lastname: Lu
authors.forename: H H
authors.initials: HH
authors.lastname: Zhu
authors.forename: Y Y
authors.initials: YY
authors.lastname: Lai
authors.forename: B
authors.initials: B
authors.lastname: Jiang
authors.forename: X J
authors.initials: XJ
authors.lastname: Huang
authors.forename: Q
authors.initials: Q
authors.lastname: Jiang
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols; D001772:Blood Cell Count; D001853:Bone Marrow / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D007962:Leukocytes / Q000166:cytology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis*; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult