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Rapid rate of peripheral blood blast clearance accurately predicts complete remission in acute myeloid leukemia

Leukemia volume 28, pages 713–716 (2014)Cite this article

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With intensive chemotherapy, many acute myeloid leukemia (AML) patients will enter complete remission (CR).1 Monitoring during induction therapy remains largely empirical: the bone marrow is typically re-examined 14 days after initiating induction therapy with cytarabine and an anthracycline (‘7+3’) or a ‘7+3’-like regimen, and re-treatment is commonly considered if significant amounts of residual blasts remain. This practice is based on the correlation between marrow blast percentage early after induction and the probability of subsequent CR.2, 3, 4, 5 However, this relationship was mostly studied in patients undergoing double-induction therapy,2, 4, 5 and many patients receiving single induction will enter CR without additional therapy despite substantial amounts of residual marrow blasts on day 14,6 leaving considerable uncertainty about the value of early marrow assessments.

An emerging alternative approach to predict the efficacy of induction therapy is offered by the assessment of peripheral blood blast (PBB) dynamics, as pioneered in acute lymphoblastic leukemia (ALL).7 In AML, rapid clearance of PBB, determined either by manual differential blood counts or by flow cytometry, is predictive of CR (likelihood of 76–90%) and overall survival.8, 9, 10, 11, 12 Here, we investigated whether mathematical modeling of early PBB dynamics using automated complete blood cell (CBC) counts could further refine the ability to predict CR after one course of induction chemotherapy.

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Acknowledgements

This study is supported by a grant from the National Cancer Institute/National Institutes of Health (P30-CA015704-35S6 to RBW). SAB is the recipient of a Trainee Research Award from the American Society of Hematology.

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Author notes

  1. V Vainstein and S A Buckley: These authors shared first authorship.

Authors and Affiliations

  1. Division of Hematology, Hadassah Medical Center, Ein Kerem, Jerusalem, Israel

    V Vainstein

  2. Department of Medicine, Residency Program, University of Washington, Seattle, WA, USA

    S A Buckley

  3. RSIP, Tel Aviv, Israel

    O Shukron

  4. Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA

    E H Estey, J L Abkowitz & R B Walter

  5. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    E H Estey & R B Walter

  6. Department of Laboratory Medicine, Division of Hematopathology, University of Washington, Seattle, WA, USA

    B L Wood

  7. Department of Epidemiology, University of Washington, Seattle, WA, USA

    R B Walter

Authors
  1. V Vainstein
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  2. S A Buckley
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  4. E H Estey
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Corresponding author

Correspondence to R B Walter.

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Competing interests

VV is a clinical advisor for Neuromedicines Inc., Pasadena, CA, USA. The remaining authors declare no conflict of interest.

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Author contributions

VV and RBW designed and performed research, analyzed and interpreted data and wrote the manuscript. SAB collected data, analyzed and interpreted data and wrote the manuscript. OS performed statistical analyses, analyzed and interpreted data and wrote the manuscript. EHE, JLA and BLW analyzed and interpreted data and wrote the manuscript.

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Vainstein, V., Buckley, S., Shukron, O. et al. Rapid rate of peripheral blood blast clearance accurately predicts complete remission in acute myeloid leukemia. Leukemia 28, 713–716 (2014). https://doi.org/10.1038/leu.2013.341

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