Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Division of Hematology, Department of Medicine, Western University, London, ON, Canada.
Clin Lymphoma Myeloma Leuk. 2020 Jul;20(7):e427-e436. doi: 10.1016/j.clml.2020.02.012. Epub 2020 Feb 26.
The 2017 National Comprehensive Cancer Network guidelines for acute myeloid leukemia have recommended performing bone marrow (BM) aspiration and BM trephine biopsy (BMTB) 14 to 21 days after starting induction therapy (commonly referred to as "day 14 [D14] marrow"). Those who do not achieve a hypoplastic marrow, with cellularity < 20% and blasts < 5%, are recommended to undergo 2-cycle induction (2CI). We performed a retrospective analysis to determine the impact of D14 BM characteristics in predicting for remission, association with overall survival (OS), and the effect of 2CI according to the D14 BM results.
Patients aged 18 to 70 years undergoing induction therapy with standard "7 + 3" regimens were included. D14 cellularity was determined from BMTB samples and the blast percentage was assessed by morphology on BM aspiration and BMTB samples. The outcomes evaluated included the rates of complete remission (CR) and OS.
A total of 486 patients with results from D14 BM evaluation were included in the present study. On multivariate analysis, cytogenetic risk and D14 blasts < 5% were predictive of CR/CR with incomplete count recovery (P < .001). Cytogenetic risk (P < .001), age < 60 years (P = .001), and D14 blasts < 5% (P = .045) predicted for OS. 2CI was performed in 131 patients (27%). Patients with hypocellular D14 BM but residual blasts (n = 106) underwent 2CI in 46% of cases, with improved remission rates (43.9% vs. 72.0%; P = .004) but no difference in OS.
The results from D14 BM evaluations are predictive of subsequent remission and OS. Our findings did not show a survival benefit with D14 BM-driven 2CI.
2017 年美国国家综合癌症网络（National Comprehensive Cancer Network，NCCN）急性髓系白血病指南建议在诱导治疗开始后 14 至 21 天（通常称为“第 14 天[D14]骨髓”）进行骨髓（BM）抽吸和 BM 活检（BMTB）。对于未达到骨髓细胞减少症，细胞成分<20%且原始细胞<5%的患者，建议进行 2 个周期的诱导（2CI）。我们进行了一项回顾性分析，以确定 D14BM 特征在预测缓解、与总生存（OS）的相关性以及根据 D14BM 结果进行 2CI 的效果。
纳入年龄在 18 至 70 岁之间接受标准“7+3”方案诱导治疗的患者。从 BMTB 样本中确定 D14 细胞成分，通过 BM 抽吸和 BMTB 样本中的形态学评估原始细胞百分比。评估的结果包括完全缓解（CR）率和 OS。
共有 486 例患者的 D14BM 评估结果纳入本研究。多变量分析显示，细胞遗传学风险和 D14 原始细胞<5%是 CR/CR 伴不完全计数恢复的预测因素（P<.001）。细胞遗传学风险（P<.001）、年龄<60 岁（P=.001）和 D14 原始细胞<5%（P=.045）预测 OS。131 例患者（27%）接受了 2CI。D14BM 细胞减少但仍有残留原始细胞的患者（n=106）中有 46%接受了 2CI，缓解率提高（43.9%对 72.0%；P=.004），但 OS 无差异。
D14BM 评估结果可预测随后的缓解和 OS。我们的研究结果并未显示 D14BM 驱动的 2CI 具有生存获益。
