Bone marrow aspirate on the 14(th) day of induction treatment as a prognostic tool in de novo adult acute myeloid leukemia

Background and Objectives, In adult acute myeloid leukemia (AML) a variety of clinical and biological parameters have been examined for their potentia l value in predicting treatment response. Early response, to induction ther apy could be an important prognostic factor in this disease. Design and Methods. We studied the relationship between reduced blasts in b one marrow aspirate on the 14(th) day (BMA14(th)) of induction chemotherapy and treatment outcome in 198 adult AML patients of whom 124 were < 60 year s old (group A) and 74 <greater than or equal to> 60 years old (group B). R eceiver operating characteristic curve analysis was used to assess the prog nostic performance of BMA14(th). Using the percentages of blasts of less th an or equal to 22% and less than or equal to 15% as criteria for predicting treatment outcome gave the highest accuracy in terms of sensitivity and sp ecificity in groups A and B, respectively. Results. In group A, of 97 patients with a BMA14(th) less than or equal to 22%, 77 (79%) achieved complete remission (CR). whereas of 27 patients with a BMA14(th) >22%, 22 (81%) were non-responders (NR) (p < 0.0001). The test sensitivity and specificity were 93.9% and 71.4%, respectively. In group B , of 27 patients with a BMA14(th) <less than or equal to> 15%, 18 (67%) ach ieved CR, whereas of 47 patients with a BMA14(th) >15%, 38 (81%) were NR (p = 0.0001), The test sensitivity and specificity were 66.7% and 80.9%, resp ectively, interpretation and Conclusions, Our data suggest that BMA14(th) m ay be a predictive test for CR, helping to identify NR patients early in th eir disease. Further studies are needed to establish the practical implicat ions of the results of our study. (C) 2000; Ferrata Storti Foundation.