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Published on: March 5, 2018
Re-induction therapy decisions based on day 14 bone marrow biopsy in acute myeloid leukemia
Tod A Morris1, Carlos M DeCastro, Louis F Diehl
1Division of Medical Oncology, Duke University Health System, Durham, NC, USA.
Purpose:
The decision to re-induce patients with acute myeloid leukemia (AML) based on results of the day 14 bone marrow (BM) biopsy is variable and lacks evidence based data. The aim of our review was to evaluate the accuracy of a day 14 BM biopsy in determining the need for re-induction chemotherapy.
Methods:
Seventy-four patients with newly diagnosed de novo AML treated with induction chemotherapy were retrospectively reviewed for the purpose of evaluating treatment decisions and outcomes based on their day 14 BM biopsy. Response to therapy in this analysis was based on morphology alone.
Results:
Of the 74 patients undergoing standard induction, 45 patients (61%) had no evidence of leukemia on their day 14 BM biopsy. Eighteen patients (24%) had definitive residual disease (RD), and 11 patient's (15%) were classified as indeterminate response (IR). Fifteen patients with RD and one with IR underwent re-induction chemotherapy. However, thirteen patients (3 RD and 10 IR) were observed until count recovery without any re-induction therapy. Eleven of these 13 patients who were observed eventually attained a morphologic complete remission (CR), including two patients with RD.
Conclusions:
A day 14 BM biopsy may have suboptimal sensitivity for the detection of residual leukemia. Some patients with an IR on day 14 may not require re-induction chemotherapy, but instead, may benefit from careful observation until count recovery to avoid the mortality and morbidity associated with re-induction chemotherapy.
Insights
Day 14 bone marrow biopsies for acute myeloid leukemia (AML) may not accurately detect residual disease. Some patients with indeterminate response may achieve remission with observation, avoiding unnecessary re-induction chemotherapy.
Area of Science:
- Hematology
- Oncology
- Clinical Research
Background:
- The decision for re-induction chemotherapy in acute myeloid leukemia (AML) often relies on day 14 bone marrow (BM) biopsy results.
- Current practices lack robust evidence, leading to variability in treatment decisions.
Purpose of the Study:
- To evaluate the accuracy of day 14 BM biopsy in guiding re-induction chemotherapy decisions for AML patients.
- To assess the impact of treatment decisions based on day 14 BM biopsy on patient outcomes.
Main Methods:
- Retrospective review of 74 newly diagnosed de novo AML patients.
- Analysis of treatment decisions and outcomes based on day 14 BM biopsy findings.
- Response assessment solely based on morphological evaluation of BM biopsy.
Main Results:
- 61% of patients showed no evidence of leukemia on day 14 BM biopsy.
- 24% had definitive residual disease (RD), and 15% had indeterminate response (IR).
- 11 of 13 patients (3 RD, 10 IR) observed without re-induction achieved morphologic complete remission (CR).
Conclusions:
- Day 14 BM biopsy may have limited sensitivity in detecting residual leukemia.
- Observation without re-induction may be suitable for some AML patients with indeterminate response, potentially reducing treatment-related morbidity and mortality.
- Careful monitoring until count recovery can be a viable alternative to immediate re-induction chemotherapy.
