Routine interim disease assessment in patients undergoing induction chemotherapy for acute myeloid leukemia: Can we do better?

Germán Campuzano-Zuluaga, Yehuda Deutsch, Matthew Salzberg, Alexandra Gomez, Fernando Vargas, Roy Elias, Deukwoo Kwon, Mark Goodman, Offiong Ikpatt, Jennifer Chapman-Fredricks, Justin Watts, Francisco Vega, Ronan T Swords

Research output: Contribution to journalArticle

6 Citations (Scopus)

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). 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.

Original languageEnglish (US)
JournalAmerican Journal of Hematology
DOIs
StateAccepted/In press - 2016

Fingerprint

Induction Chemotherapy
Acute Myeloid Leukemia
Bone Marrow
Cytogenetics
Retrospective Studies
Prospective Studies
Drug Therapy

ASJC Scopus subject areas

  • Hematology

Cite this

Campuzano-Zuluaga, G., Deutsch, Y., Salzberg, M., Gomez, A., Vargas, F., Elias, R., ... Swords, R. T. (Accepted/In press). Routine interim disease assessment in patients undergoing induction chemotherapy for acute myeloid leukemia: Can we do better? American Journal of Hematology. https://doi.org/10.1002/ajh.24271

Routine interim disease assessment in patients undergoing induction chemotherapy for acute myeloid leukemia : Can we do better? / Campuzano-Zuluaga, Germán; Deutsch, Yehuda; Salzberg, Matthew; Gomez, Alexandra; Vargas, Fernando; Elias, Roy; Kwon, Deukwoo; Goodman, Mark; Ikpatt, Offiong; Chapman-Fredricks, Jennifer; Watts, Justin; Vega, Francisco; Swords, Ronan T.

In: American Journal of Hematology, 2016.

Research output: Contribution to journalArticle

@article{e73a4255480c476db1d9887171cc2e8b,
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). 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.",
author = "Germ{\'a}n Campuzano-Zuluaga and Yehuda Deutsch and Matthew Salzberg and Alexandra Gomez and Fernando Vargas and Roy Elias and Deukwoo Kwon and Mark Goodman and Offiong Ikpatt and Jennifer Chapman-Fredricks and Justin Watts and Francisco Vega and Swords, {Ronan T}",
year = "2016",
doi = "10.1002/ajh.24271",
language = "English (US)",
journal = "American Journal of Hematology",
issn = "0361-8609",
publisher = "Wiley-Liss Inc.",

}

TY - JOUR

T1 - Routine interim disease assessment in patients undergoing induction chemotherapy for acute myeloid leukemia

T2 - Can we do better?

AU - Campuzano-Zuluaga, Germán

AU - Deutsch, Yehuda

AU - Salzberg, Matthew

AU - Gomez, Alexandra

AU - Vargas, Fernando

AU - Elias, Roy

AU - Kwon, Deukwoo

AU - Goodman, Mark

AU - Ikpatt, Offiong

AU - Chapman-Fredricks, Jennifer

AU - Watts, Justin

AU - Vega, Francisco

AU - Swords, Ronan T

PY - 2016

Y1 - 2016

N2 - 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). 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.

AB - 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). 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.

UR - http://www.scopus.com/inward/record.url?scp=84954534504&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84954534504&partnerID=8YFLogxK

U2 - 10.1002/ajh.24271

DO - 10.1002/ajh.24271

M3 - Article

C2 - 26663264

AN - SCOPUS:84959088125

JO - American Journal of Hematology

JF - American Journal of Hematology

SN - 0361-8609

ER -