Correlation of Day 8 Steroid Response with Bone Marrow Status Measured on Days 14 and 35, in Patients with Acute Lymphoblastic Leukemia Being Treated with BFM Protocol

Berlin–Frankfurt–Munster (BFM) protocol is commonly used in India for treatment of acute lymphoblastic leukemia (ALL). The present study was conducted to correlate day 8 steroid response with bone marrow status (by morphology and flow cytometry) at day 14 and day 35 of treatment. It was a prospective study which included all newly diagnosed ALL patients who visited hospital between March 2013 and February 2015 i.e. 2 years. On 8th day, the number of lymphoblasts was counted in the peripheral blood. Based on the number of blasts patients were classified as good steroid responders and poor steroid responders. Following pre-induction steroids patients were given induction therapy. During this phase on day 14 and day 35 bone marrow (BM) aspiration study was done. Later day 8 steroid response, Day 14 BM status and day 35 BM status were correlated. Results showed that there was a statistically significant correlation between day 8 steroid response and day 14 BM status (both by morphology and flow cytometry). There was no statistically significant correlation between day 8 steroid response and day 35 BM status (both by morphology and flow cytometry). There was no statistically significant correlation between day 14 and day 35 BM status (both by morphology and flow cytometry). Sensitivity and specificity of morphological evaluation of BM was much lower compared to minimal residual disease assessment by flow cytometry. There is a need to incorporate flow cytometry in risk stratification of patients who are being treated with BFM 2002 protocol.