Acute Myeloid Leukemia Induced Remission In The Treatment Of The Prognostic Value Of The Proportion Of Residual Leukemic Cells

Objective To explore the impact of the percentage of bone marrow residual leukemic cells at theend of induction chemotherapy(T1:day 5-7of induction therapy) or during aplasia(T2:7-10 daysafter the end of induction therapy) on the prognosis of patients with de novo acute myeloidleukemia(AML).Methods 72 cases of new diagnosed de novo AML treated with HAD (homoharringtonine,cytosine arabinoside and daunorubicin) regimen were enrolled. The impact of the percentage ofresidual leukemic cells at either time point (T1 or T2) alone or combined with cytogenetics oncomplete remisson (CR) rate, disease free survival (DFS) and overall survival (OS) wereretrospectively analyzed.Results(1)The CR rate of the 72 patients was 86.1%. Midian DFS was 31 months and midian OS was notreached until now. DFS and OS rates at 3 years were 45.9% and 55.9%, respectively.(2) The patients were separated into two subgroups by a cutoff 10% bone marrow leukemic cellsat Tl or T2 time point. The CR rate(P<0.001 and P<0.001,respectively ), DFS(P<0.001 andP=0.026 ,respectively) and OS (P<0.001 and P=0.002, respectively) were significantly differentbetween the two groups.(3) The residual leukemic cells at combined time points were shown to more highly correlate withleukemic cells clearance kinetics.(4)The prognostic significance combining the percentage of residual leukemic cells withcytogenetics were better than either the percentage of residual leukemic cells or cytogenetics.Conclusion The percentage of residual leukemic cells at Tl or T2 during induction therapy is anindependent prognostic factor of AML.The impact of residual leukemic cells combined the twotime points is more significant compared with that at single time point. Early response accessmentcan help define the prognosis of the individual patient with AML. Individual therapy adapedaccording to early response accessment maybe improve the curative effect and long survival ofpatients with AML. The risk classifications based on cytogenetics combined residual leukemiccells are probably more powerful than the risk classification based only on cytogenitics, andpromise to be broadly applied in clinical practice.