Abhishek Mangaonkar 1 , Hongyan Xu 2 , Jamal Mohsin 3 , Joshua Mansour 3 , Rohini Chintalapally 3 , Ryan Keen 3 , Ashis K Mondal 4 , David DeRemer 5,6 , Amber B Clemmons 5,6 , Stephen M Clark 5,6 , Arpita Shah 5,6 , Anand Jillela 7 , Ravindra Kolhe 4 , Vamsi Kota 7 Show Affiliations »
Abstract
BACKGROUND: Complete remission (CR) in acute myeloid leukemia (AML) is defined as having ≤5% leukemic blast cells in the bone marrow and return of normal hematopoiesis after the first induction cycle. There is a subset of patients, however, who achieve reduction of leukemic blast cells with a subnormal platelet count, designated as CR with incomplete platelet recovery (platelet count, ≤100,000/mcL; normal, 150,000-450,000/mcL), which is associated with inferior outcomes when compared with CR. Furthermore, there is another subset of patients with CR but superior platelet counts (≥400,000/mcL) whose prognostic significance is unclear. OBJECTIVE: To establish whether CR with superior platelet counts is associated with better outcomes and can be used as a separate entity for prognostication. METHODS: A retrospective chart review of 104 cases of AML was conducted. The highest platelet count during days 25-35 from initiation of induction chemotherapy (designated as day 30 platelet count) was documented. A multivariate analysis for other factors such as age, sex, risk categories, day 14+ plasma cell count (average plasma cell percentage at days 14-21), infections, allogeneic bone marrow transplant, and remission status was done. RESULTS: Day 30 platelet count was found to be an independent predictor of survival in AML. On the multivariate analysis, the subgroup with superior platelet counts (≥400,000/mcL) was found to be associated with better outcomes. LIMITATIONS: Results need to be validated in a larger cohort. CONCLUSIONS: CR with superior platelet recovery (≥400,000/mcL) is a unique subcategory in itself and has prognostic significance. This may help better assess response to chemotherapeutic agents and aid in further decision-making regarding treatment. ©2016 Frontline Medical Communications.
BACKGROUND: Complete remission (CR ) in acute myeloid leukemia (AML ) is defined as having ≤5% leukemic blast cells in the bone marrow and return of normal hematopoiesis after the first induction cycle. There is a subset of patients , however, who achieve reduction of leukemic blast cells with a subnormal platelet count, designated as CR with incomplete platelet recovery (platelet count, ≤100,000/mcL ; normal, 150,000-450,000/mcL ), which is associated with inferior outcomes when compared with CR . Furthermore, there is another subset of patients with CR but superior platelet counts (≥400,000/mcL ) whose prognostic significance is unclear. OBJECTIVE: To establish whether CR with superior platelet counts is associated with better outcomes and can be used as a separate entity for prognostication. METHODS: A retrospective chart review of 104 cases of AML was conducted. The highest platelet count during days 25-35 from initiation of induction chemotherapy (designated as day 30 platelet count) was documented. A multivariate analysis for other factors such as age, sex, risk categories, day 14+ plasma cell count (average plasma cell percentage at days 14-21), infections , allogeneic bone marrow transplant, and remission status was done. RESULTS: Day 30 platelet count was found to be an independent predictor of survival in AML . On the multivariate analysis, the subgroup with superior platelet counts (≥400,000/mcL ) was found to be associated with better outcomes. LIMITATIONS: Results need to be validated in a larger cohort. CONCLUSIONS: CR with superior platelet recovery (≥400,000/mcL ) is a unique subcategory in itself and has prognostic significance. This may help better assess response to chemotherapeutic agents and aid in further decision-making regarding treatment. ©2016 Frontline Medical Communications.
Entities: Chemical
Disease
Gene
Species
Keywords:
acute myeloid leukemia; complete remission; day 30 platelet count; survival
Year: 2016
PMID： 26955659 DOI： 10.12788/jcso.0231
Source DB: PubMed Journal: J Community Support Oncol ISSN： 2330-7749