• Users Online: 273
  • Print this page
  • Email this page


 
 
Table of Contents
LETTER TO EDITOR
Year : 2022  |  Volume : 5  |  Issue : 1  |  Page : 156-157

Authors' reply to Chaudhary et al. and Soni et al.


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

Date of Submission06-Feb-2022
Date of Decision03-Mar-2022
Date of Acceptance03-Mar-2022
Date of Web Publication31-Mar-2022

Correspondence Address:
Chandran K Nair
Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalaserry, Kannur - 670 103, Kerala
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_76_22

Rights and Permissions

How to cite this article:
Manuprasad A, Raghavan V, Shenoy PK, Krishnan A, Nair CK. Authors' reply to Chaudhary et al. and Soni et al. Cancer Res Stat Treat 2022;5:156-7

How to cite this URL:
Manuprasad A, Raghavan V, Shenoy PK, Krishnan A, Nair CK. Authors' reply to Chaudhary et al. and Soni et al. Cancer Res Stat Treat [serial online] 2022 [cited 2022 May 21];5:156-7. Available from: https://www.crstonline.com/text.asp?2022/5/1/156/341288



We thank Chaudhary et al.[1] and Soni et al.[2] for their interest in our work and for critically evaluating our article titled, “The utility of day 14 bone marrow response assessment in patients undergoing acute myeloid leukemia induction: A single institution retrospective experience.”[3] This study was undertaken to assess the utility of a practice that has been widely adopted but that has not been studied in a randomized setting. Also, the impact of day 14 bone marrow assessment in the Indian setting is far different from that in the western world, considering the unique challenges we face in managing acute myeloid leukemia.[4] Even though day 14 bone marrow evaluation is recommended by all major guidelines, there are many published studies that question its utility. The issues related to this practice range from the technical difficulties associated with interpretation, as pointed out by Chaudhary et al., to the low specificity for the prediction of residual disease, as highlighted by Mirgh.[5] In our study as well, day 14 marrow examination and reinduction based on the response were of doubtful benefit. However, the prognostic value of adequate response in day 14 bone marrow examination is something that cannot be ignored, as all patients with adequate interim response achieved complete response (CR) at the end of induction.

One of the major reasons for the “futility” of this practice is that many patients without adequate bone marrow response may achieve CR without additional chemotherapy, and this could be related to delayed blast clearance due to slower kinetics. Moreover, as rightly highlighted by Chaudhary et al.,[1] only half of our patients who showed an inadequate day 14 bone marrow response were fit to receive a second induction. This limits the utility of this practice in clinical decision-making in our country. Considering all of these factors, we agree with Chaudhary et al.,[1] Soni et al.,[2] and Mirgh that the practice of day 14 bone marrow assessment cannot be routinely recommended in the Indian setting. At the same time, identifying patients who are less likely to respond and intensifying their treatment is even more important in the Indian context, where there is limited access to novel agents and allogeneic hematopoietic stem cell transplant. As rightly suggested by Soni et al.,[2] the incorporation of other parameters, like minimal residual disease, is a potential strategy that is yet to be explored.[6] However, before abandoning this strategy, which is widely practiced across different centers, we need to study the problem more systematically. Despite the various limitations of our study, we believe that it will evoke a debate on this important issue and will pave the way for addressing this question by means of multicenter collaborations in India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chaudhary S, Ganguly S, Bakhshi S. Day 14 bone marrow response assessment in acute myeloid leukemia: Should we discontinue? Cancer Res Stat Treat 2022;5:153-4.  Back to cited text no. 1
  [Full text]  
2.
Soni P, Gupta N, Malhotra H. The day 14 conundrum still remains unresolved! Cancer Res Stat Treat 2022;5:155-6.  Back to cited text no. 2
    
3.
Manuprasad A, Raghavan V, Shenoy PK, Krishnan A, Nair CK. The utility of day 14 bone marrow response assessment in patients undergoing acute myeloid leukemia induction: A single institution retrospective experience. Cancer Res Stat Treat 2021;4:628-33.  Back to cited text no. 3
  [Full text]  
4.
Nayak L. Optimizing acute leukemia treatment in resource-constrained settings. Cancer Res Stat Treat 2020;3:287-9.  Back to cited text no. 4
  [Full text]  
5.
Mirgh SP. (F) utility of day 14 bone marrow in acute myeloid leukemia on 3+7 induction – Is it time to bid adieu to day 14 bone marrow? Cancer Res Stat Treat 2021;4:731-3.  Back to cited text no. 5
  [Full text]  
6.
Pullarkat V, Aldoss I. Prognostic and therapeutic implications of early treatment response assessment in acute myeloid leukemia. Crit Rev Oncol Hematol 2015;95:38-45.  Back to cited text no. 6
    




 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
References

 Article Access Statistics
    Viewed128    
    Printed4    
    Emailed0    
    PDF Downloaded15    
    Comments [Add]    

Recommend this journal