The role of interim bone marrow assessments in acute myeloid leukemia - A systematic review and meta-analysis
Yuanli Lei1, Zhiting Tang2, Jessica A Reese3
1Section of Hospital Medicine, Department of Internal Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, USA.
Background:
The current standard of care for acute myeloid leukemia (AML) patients undergoing intensive induction chemotherapy includes an interim bone marrow biopsy around day 14 (D14BM), and reinduction for patients with more than 5 % residual blasts on D14BM (Positive D14BM). However, this approach has become increasingly controversial. This systematic review and meta-analysis assess the sensitivity, specificity, and predictive value of D14BM in patients treated with one cycle of induction chemotherapy and evaluate the efficacy of reinduction versus observation in patients with Positive D14BM.
Methods:
A systematic literature search was conducted using PubMed, Embase, Web of Science, and Cochrane databases. A bivariate model was used for pooled sensitivity and specificity. The positive predictive value was estimated based on pooled mean sensitivity, specificity, and historical refractory leukemia prevalence. Risk ratios (RR) for complete remission (CR) were meta-analyzed to compare reinduction versus observation in Positive D14BM patients.
Result:
Among 1044 identified articles, 12 met inclusion criteria. Ten studies (1683 patients) evaluated the predictive value of D14BM, with a sensitivity of 49.7 % (proportion of refractory cases correctly identified by Positive D14BM) and specificity of 86.2 %. The estimated positive predictive value was 38.9 %, assuming a 15 % prevalence of true refractory leukemia. Eleven studies (832 patients) evaluated efficacy of reinduction, with a pooled RR of 1.00 (61 % vs. 60 %, 95 % CI: 0.76-1.31) for CR.
Conclusion:
Positive D14BM has limited predictive power for refractory leukemia. Reinduction based on Positive D14BM does not improve CR rates compared to observation alone only and may expose patients to undue toxicity.
Insights
Day 14 bone marrow biopsy (D14BM) has limited predictive power for acute myeloid leukemia (AML) refractory status. Reinduction therapy based on D14BM does not improve complete remission rates in AML patients.
Area of Science:
- Hematology
- Oncology
- Clinical Trials
Background:
- Current acute myeloid leukemia (AML) treatment involves interim bone marrow biopsy on day 14 (D14BM) to guide reinduction therapy for patients with >5% residual blasts (Positive D14BM).
- The clinical utility of D14BM and subsequent reinduction strategies is increasingly debated.
Purpose of the Study:
- To systematically review and meta-analyze the sensitivity, specificity, and predictive value of D14BM in AML patients.
- To evaluate the efficacy of reinduction versus observation in patients with Positive D14BM.
Main Methods:
- Systematic literature search of PubMed, Embase, Web of Science, and Cochrane databases.
- Bivariate model for pooled sensitivity and specificity; positive predictive value estimated using historical refractory leukemia prevalence.
- Meta-analysis of risk ratios (RR) for complete remission (CR) comparing reinduction and observation.
Main Results:
- Twelve studies (1683 patients) evaluated D14BM predictive value: sensitivity 49.7%, specificity 86.2%, positive predictive value 38.9%.
- Eleven studies (832 patients) evaluated reinduction efficacy: pooled RR for CR was 1.00 (61% vs. 60%, 95% CI: 0.76-1.31).
Conclusions:
- Positive D14BM demonstrates limited predictive capability for identifying refractory leukemia.
- Reinduction therapy guided by Positive D14BM does not enhance CR rates compared to observation and may increase patient toxicity.
