Predictors for requiring re-induction chemotherapy in acute myeloid leukemia patients with residual disease on day 14 bone marrow assessment

Abstract

PurposeDay 14 bone marrow (BM) biopsies following standard induction in acute myeloid leukemia (AML) have a suboptimal ability to predict complete remission (CR). The decision to administer re-induction chemotherapy with residual disease on day 14 is variable and lacks clear guidance. MethodsWe retrospectively compared clinical and laboratory characteristics of adult patients with newly diagnosed, previously untreated AML who underwent 3+7 induction chemotherapy from January 2004 until February 2017. ResultsOf 90 patients with a positive day 14 BM biopsy, 53 did not receive immediate re-induction chemotherapy. Twenty-seven (51%) of those patients achieved a CR upon count recovery. Favorable risk cytogenetics was found to be highly significant for attaining a CR at repeat BM biopsy. ConclusionsDay 14 BM evaluations following 3+7 induction are unable to accurately predict the ability to achieve a CR. Many patients will attain a CR despite no further chemotherapy. The decision to re-induce can be safely delayed in many patients, especially those with favorable risk cytogenetics.