Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
Clin Lymphoma Myeloma Leuk. 2020 Jan;20(1):31-38. doi: 10.1016/j.clml.2019.09.613. Epub 2019 Sep 28.
The benefit of immediate reinduction chemotherapy for patients with indeterminate day 14 bone marrow results (≤ 20% cellularity and 5%-20% blasts) remains unclear. We report our experience with patients with acute myeloid leukemia (AML) with indeterminate day 14 bone marrow biopsy results treated with reinduction chemotherapy versus observation alone.
We performed a retrospective study to assess the outcomes of adult patients with newly diagnosed AML treated with or without reinduction chemotherapy for indeterminate day 14 bone marrow results.
We identified 50 patients with indeterminate day 14 bone marrow results. Of the 50 patients, 25 (50%) had received reinduction therapy and 25 (50%) had not. Of the 50 patients, 24 (48%) had poor risk disease, 12 in the reinduction arm (10 with an abnormal karyotype and 2 with a normal karyotype with molecular abnormalities) and 12 in the observation arm (6 with an abnormal karyotype and 6 with a normal karyotype with molecular abnormalities). The overall response rate (complete remission plus complete remission with incomplete count recovery) was similar in both treatment arms (80% vs. 80%). No statistically significant difference was found in the median overall survival (13 months vs. 21 months; P = .88) or relapse-free survival (13 months vs. 33 months; P = .53) between the 2 treatment arms.
Our study did not find a statistically significant difference in the overall response rates or survival outcome measures for patients with AML and indeterminate day 14 bone marrow in the 2 treatment groups. Our findings question the utility of immediate reinduction chemotherapy and raise concern regarding overtreatment in this patient population. Larger studies investigating similar outcomes are warranted to validate our clinical findings.
对于第 14 天骨髓结果不确定（≤20%细胞和 5%-20%原始细胞）的患者，立即进行再诱导化疗的益处尚不清楚。我们报告了对接受再诱导化疗与单纯观察治疗的第 14 天骨髓活检结果不确定的急性髓系白血病（AML）患者的经验。
我们进行了一项回顾性研究，以评估接受或不接受第 14 天骨髓结果不确定的再诱导化疗的新诊断为 AML 的成年患者的结局。
我们确定了 50 例第 14 天骨髓结果不确定的患者。在这 50 例患者中，有 25 例（50%）接受了再诱导治疗，25 例（50%）未接受。在这 50 例患者中，有 24 例（48%）患有高危疾病，在再诱导组中，有 12 例（10 例核型异常和 2 例核型正常伴分子异常），在观察组中，有 12 例（6 例核型异常和 6 例核型正常伴分子异常）。两组的总体缓解率（完全缓解加不完全计数恢复的完全缓解）相似（80%比 80%）。两组之间的中位总生存（13 个月比 21 个月；P=0.88）或无复发生存（13 个月比 33 个月；P=0.53）无统计学差异。
我们的研究未发现两组患者在第 14 天骨髓结果不确定的 AML 患者中，总体反应率或生存结果测量指标存在统计学差异。我们的研究结果对立即进行再诱导化疗的效用提出了质疑，并对该患者群体的过度治疗提出了关注。需要进行更大规模的研究来验证我们的临床发现。
