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Low platelet count reduces subsequent complete remission rate despite marrow with <5% blasts after AML induction therapy

Leukemia volume 29, pages 1779–1780 (2015)Cite this article

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After initial induction chemotherapy for acute myeloid leukemia (AML), convention and guidelines1 suggest observation without therapy if a post-treatment bone marrow shows <5% myeloblasts, even given persistently low absolute neutrophil counts (ANC) and/or platelet counts. Such practice implies that complete remission (CR; ANC ⩾1000/μl and platelet count ⩾100 000/μl in addition to <5% marrow blasts by morphology)2 might occur without further therapy. Herein we examine the relation between ANC and platelet count in patients with <5% marrow blasts on day 21 of course 1 of chemotherapy and subsequent probabilities of CR without additional therapy and of survival.

Our database comprised 343 patients with newly diagnosed AML (acute promyelocytic leukemia excluded) or myelodysplastic syndrome with 15–19% blasts treated here from 2008 to 2011. We included 85 of these in whom a marrow aspirate on post-treatment day 21–28, 29–35, 36–42 or 43–49 contained <5% blasts, as determined morphologically and by multi-parameter flow cytometry (MFC), but in whom blood count criteria for CR had yet to be met. If more than one marrow was examined between days 21 and 49 only the first one was included. We used Cox regression for multivariate analyses to estimate the independent effects of platelet count and ANC, and time when the marrow associated with these counts was obtained (for example, day 21–28) on probability of course 1 CR and of survival. The 85 patients had a median age of 54 years, with Southwest Oncology Group (SWOG) intermediate, unfavorable and favorable cytogenetics3 in 52%, 38% and 10%, respectively, and with secondary AML (after an antecedent hematologic disorder or therapy related) in 48%. Sixty-six percent received standard ‘3+7’, 21% received higher and 4% lower doses of cytarabine, while 9% received therapy without cytarabine (none with hypomethylating agents). Sixty-four percent achieved CR on the first course of therapy. Median survival was 13.1 months.

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Authors and Affiliations

  1. Department of Laboratory Medicine, University of Washington, Seattle, WA, USA

    X Chen

  2. Division of Hematology and Medical Oncology, Department of Medicine, Oregon Health & Science University (OHSU) Knight Cancer Institute, Portland, OR, USA

    L F Newell

  3. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    H Xie, R B Walter, J M Pagel, V K Sandhu, P S Becker, F R Appelbaum & E H Estey

  4. Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA

    R B Walter, P S Becker, P C Hendrie, J L Abkowitz & E H Estey

  5. Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA

    R B Walter, J M Pagel, P S Becker, F R Appelbaum & E H Estey

Authors
  1. X Chen
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  2. L F Newell
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  3. H Xie
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  4. R B Walter
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  5. J M Pagel
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  6. V K Sandhu
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  7. P S Becker
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  8. P C Hendrie
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  9. J L Abkowitz
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  10. F R Appelbaum
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  11. E H Estey
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Correspondence to E H Estey.

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Chen, X., Newell, L., Xie, H. et al. Low platelet count reduces subsequent complete remission rate despite marrow with <5% blasts after AML induction therapy. Leukemia 29, 1779–1780 (2015). https://doi.org/10.1038/leu.2015.23

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