|LETTER TO EDITOR
|Year : 2022 | Volume
| Issue : 1 | Page : 156-157
Authors' reply to Chaudhary et al. and Soni et al.
Avaronnan Manuprasad, Vineetha Raghavan, Praveen K Shenoy, Aswathi Krishnan, Chandran K Nair
Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalaserry, Kerala, India
|Date of Submission||06-Feb-2022|
|Date of Decision||03-Mar-2022|
|Date of Acceptance||03-Mar-2022|
|Date of Web Publication||31-Mar-2022|
Chandran K Nair
Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalaserry, Kannur - 670 103, Kerala
Source of Support: None, Conflict of Interest: None
|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
We thank Chaudhary et al. and Soni et al. 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.” 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. 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. 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., 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., Soni et al., 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., the incorporation of other parameters, like minimal residual disease, is a potential strategy that is yet to be explored. 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
Conflicts of interest
There are no conflicts of interest.
| References|| |
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. [Full text]
Soni P, Gupta N, Malhotra H. The day 14 conundrum still remains unresolved! Cancer Res Stat Treat 2022;5:155-6.
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. [Full text]
Nayak L. Optimizing acute leukemia treatment in resource-constrained settings. Cancer Res Stat Treat 2020;3:287-9. [Full text]
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. [Full text]
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.