Predictors for requiring re-induction chemotherapy in acute myeloid leukemia patients with residual disease on day 14 bone marrow assessment.

ABSTRACT

PURPOSE: Day 14 bone marrow (BM) biopsies following standard induction in acute myeloid leukemia (AML) have a suboptimal ability to predict complete remission (CR). The decision to administer re-induction chemotherapy with residual disease on day 14 is variable and lacks clear guidance. METHODS: We retrospectively compared clinical and laboratory characteristics of adult patients with newly diagnosed, previously untreated AML who underwent 3+7 induction chemotherapy from January 2004 until February 2017. RESULTS: Of 90 patients with a positive day 14 BM biopsy, 53 did not receive immediate re-induction chemotherapy. Twenty-seven (51%) of those patients achieved a CR upon count recovery. Favorable risk cytogenetics was found to be highly significant for attaining a CR at repeat BM biopsy. CONCLUSIONS: Day 14 BM evaluations following 3+7 induction are unable to accurately predict the ability to achieve a CR. Many patients will attain a CR despite no further chemotherapy. The decision to re-induce can be safely delayed in many patients, especially those with favorable risk cytogenetics.