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Year : 2021  |  Volume : 4  |  Issue : 4  |  Page : 628-633

The utility of day 14 bone marrow response assessment in patients undergoing acute myeloid leukemia induction: A single institution retrospective experience

Department Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalaserry, Kerala, India

Correspondence Address:
Chandran K Nair
Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalaserry, Kannur - 670 103, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/crst.crst_90_21

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Background: Examination of the bone marrow on day 14 of induction chemotherapy for acute myeloid leukemia (AML) is a common practice. However, the evidence for re-inducing the patient based on early bone marrow response is limited. Objectives: This study was aimed at assessing the utility of bone marrow examination on day 14 of AML induction in predicting complete remission (CR) or residual disease and its impact on clinical decisions on re-induction in a resource-limited setting. Materials and Methods: This retrospective study was conducted at the Malabar Cancer Center, a tertiary cancer center in Kerala, India. Adult patients with AML who received 3 + 7 (daunorubicin + cytarabine) induction chemotherapy from January 2011 to December 2018 and underwent an early bone marrow examination on day 14 were included in the study. Early marrow response was considered adequate if the marrow cellularity was less than 15%–20%, with less than 5%–10% blasts. Patients with inadequate bone marrow response were given re-induction chemotherapy, if eligible. Unfit patients were continued on supportive measures. The end-of-induction bone marrow was done on day 28 after count recovery. Case records of all patients were reviewed, and data including the baseline characteristics, day 14 bone marrow response, and post-induction marrow status were collected. Results: Of the 96 patients who received induction chemotherapy during the study period, 78 underwent day 14 bone marrow assessment. The median age was 44 years (range, 15-66), and 43% of the patients were males. On day 14, 57 (73%) patients had adequate bone marrow response, 19 (24%) had inadequate response, and 2 (3%) had inconclusive results. Among the patients with inadequate responses, 12 attained CR at the end of induction, although only 9 received re-induction. Adequate day 14 bone marrow had a sensitivity of 89.8% (95% confidence interval [CI], 79–96) in predicting the remission status at the end of induction. The specificity of inadequate day 14 marrow response in predicting residual disease in post-induction bone marrow was 89% (95% CI, 79–96). Similarly, the positive predictive value was 100% and the negative predictive value was 14%. Conclusion: Although assessment of day 14 bone marrow response is useful in predicting the chances of CR at the end of induction, its role in guiding the decision for re-induction is doubtful, and larger studies are needed to address this question.

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