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  • Original Article
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Sensitivity and Resistance to Therapy

Early clearance of peripheral blasts measured by flow cytometry during the first week of AML induction therapy as a new independent prognostic factor: a GOELAMS study

Leukemia volume 23, pages 350–357 (2009)Cite this article

Abstract

An early appreciation of treatment efficacy could be very useful in acute myeloblastic leukemia (AML), and a prognostic value has been suggested for the morphological assessment of decrease in blasts during induction therapy. More sensitive, multiparametric flow cytometry (FCM) can detect far lower blast counts, allowing for a precise and reliable calculation of blast cell decrease rate (BDR). Such a multiparametric FCM four-colours/single-tube protocol, combining CD11b, CD45-ECD and CD16-PC5, was applied to peripheral blood samples from 130 AML patients, collected daily during induction chemotherapy. Normalized blast cell percentages were used to calculate the relevant decrease slopes. Slope thresholds (<−25, −25 to −15 and >−15), or the time required to reach 90% depletion of the peripheral blast load (<5, 5 or >5 days), was strongly associated with the achievement of complete remission (P<0.0001). Log-rank test and Cox model showed that they also carried high statistical significance (P<0.0001) for disease-free survival. The prognostic value of cytogenetic features, confirmed in this series, was refined by BDR, which allowed to discriminate between good- and poor-risk patients among those with intermediate or normal karyotypes. This simple FCM protocol allows for an accurate prognostic sequential approach adapted to the determination of decrease in peripheral blast cells during induction chemotherapy.

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Acknowledgements

We are grateful to Professors Norbert Ifrah (Angers), Jean Yves Cahn (Grenoble) and Francis Belloc (Bordeaux) for fruitful discussion, Alex Briais (Bordeaux) and Marie Robert (Bordeaux) for helpful technical assistance and to cytogeneticists, respectively Drs Marina Lafage Pochitaloff and Joëlle Mozziconacci (Marseille), Francine Mugneret (Dijon) and Marie Josée Grégoire (Vandoeuvre les Nancy). This work benefited grants from the Goelams group, Fondation de France and Laurette Fugain association.

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Authors and Affiliations

  1. Hematology Laboratory, CHU Bordeaux, Hôpital Haut Levêque, Pessac, France

    F Lacombe & E Lippert

  2. Hematology Laboratory, Institut Paoli Calmettes, Marseille, France

    C Arnoulet

  3. Hematology Laboratory, CHU le Bocage, Dijon, France

    M Maynadié

  4. Hematology Laboratory, CHU Robert Debré, Reims, France

    I Luquet

  5. Hematology Clinic, CHU Bordeaux, Haut Levêque, Pessac, France

    A Pigneux

  6. Hematology Clinic, Institut Paoli Calmettes, Marseille, France

    N Vey

  7. Hematology Clinic, CHU le Bocage, Dijon, France

    O Casasnovas

  8. Hematology Clinic, CHU Brabois, Vandoeuvre-les-Nancy, France

    F Witz

  9. Immunology Laboratory, CHU Brabois, Vandoeuvre-les-Nancy, France

    M C Béné

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  1. F Lacombe
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Correspondence to M C Béné.

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Lacombe, F., Arnoulet, C., Maynadié, M. et al. Early clearance of peripheral blasts measured by flow cytometry during the first week of AML induction therapy as a new independent prognostic factor: a GOELAMS study. Leukemia 23, 350–357 (2009). https://doi.org/10.1038/leu.2008.296

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