Clinical significance of day 5 peripheral blast clearance rate in the evaluation of early treatment response and prognosis of patients with acute myeloid leukemiaReportar como inadecuado




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Journal of Hematology and Oncology

, 8:48

First Online: 10 May 2015Received: 12 February 2015Accepted: 28 April 2015DOI: 10.1186-s13045-015-0145-1

Cite this article as: Yu, C., Kong, Q., Zhang, Y. et al. J Hematol Oncol 2015 8: 48. doi:10.1186-s13045-015-0145-1

Abstract

BackgroundMinimal residual disease detection in the bone marrow is usually performed in patients with acute myeloid leukemia undergoing one course of induction chemotherapy. To optimize the chemotherapy strategies, more practical and sensitive markers are needed to monitor the early treatment response during induction. For instance, peripheral blood PB blast clearance rate may be considered as such a monitoring marker.

MethodsPB blasts were monitored through multiparameter flow cytometry MFC. Absolute counts were determined before treatment D0 and at specified time points of induction chemotherapy D3, D5, D7, and D9. The cut-off value of D5 peripheral blast clearance rate D5-PBCR was defined through receiver operating characteristic ROC analysis. Prognostic effects were compared among different patient groups according to D5-PBCR cut-off value.

ResultsD5-PBCR cut-off value was determined as 99.55%. Prognostic analysis showed that patients with D5-PBCR ≥99.55% more likely achieved complete remission 94.6% vs. 56.1%, P < 0.001 and maintained a relapse-free status than other patients 80.56% vs. 57.14%, P = 0.027. Survival analysis revealed that relapse-free survival RFS and overall survival OS were longer in patients with D5-PBCR ≥99.55% than in other patients two-year OS: 71.0% vs. 38.7%, P = 0.011; two-year RFS: 69.4% vs. 30.7%, P = 0.026. In cytogenetic-molecular intermediate-risk group, a subgroup with worse outcome could be distinguished on the basis of D5-PBCR <99.55%; OS: P = 0.033, RFS: P = 0.086.

ConclusionsAn effective evaluation method of early treatment response was established by monitoring PB blasts through MFC. D5-PBCR cut-off value 99.55% can be a reliable reference to predict treatment response and outcome in early stages of chemotherapy. The proposed marker may be used in induction regimen modification and help optimize cytogenetic-molecular prognostic risk stratification.

KeywordsPeripheral blast clearance rate Early treatment response Prognosis AML AbbreviationsALLacute lymphoblastic leukemia

allo-HSCTallogeneic hematopoietic cell transplantation

AUCarea under the curve

AMLacute myeloid leukemia

BMbone marrow

CRcomplete remission

FABFrench-American-British

LAIPleukemia-associated aberrant immunophenotype

MRDminimal residual disease

MFCmultiparameter flow cytometry

PBperipheral blood

NCRnot achieved complete remission

OSoverall survival

PBCRperipheral blasts clearance rate

PBRRPB blasts reduction ratio

RFSrelapse-free survival

ROCreceiver operating characteristic

Cong Yu, Qing-lei Kong and Yun-xiang Zhang contributed equally to this work.

Electronic supplementary materialThe online version of this article doi:10.1186-s13045-015-0145-1 contains supplementary material, which is available to authorized users.

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Autor: Cong Yu - Qing-lei Kong - Yun-xiang Zhang - Xiang-qin Weng - Jing Wu - Yan Sheng - Chun-lei Jiang - Yong-mei Zhu - Qi Cao

Fuente: https://link.springer.com/







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