Does day 14 bone marrow status predict response to chemotherapy in acute myeloid leukemia? Experience of a hemato-oncology care center from Eastern India

Background: Acute myeloid leukemia (AML), the most common type of acute leukemia in adults, yet continues to have the lowest survival rate of all leukemias. The present study aimed to study ability of Day 14 marrow status to predict the remission status in AML. Materials and Methods: This prospective, observational study conducted in 30 AML patients who received “induction remission” as per standard guidelines and undergone bone marrow (BM) aspiration and biopsy on day 14 and day 28. Complete remission (CR) defined as per standard criteria. SPSS 15.3 was used to perform statistical analysis. Results: Median BM blast count on day14 was 10.6% (range, 1–50). Patients achieving remission in day 28 + BM had mean day 14 BM blast count of 8.52% compared to 21.00% in those who did not achieve remission. Majority (90.9%) of the patients with ≤15% BM blast on D14 was in remission. Comparing D14 BM blast% with CR, blast >15% cut off (across all the cut offs, i.e., 5%, 10%, 15%, or 20%) was the best to find those who entered remission; but the negative predictive value (NPV) was poor across all groups. Conclusions: There is a trend toward early relapse in patients with higher blast on D14. However, D14 BM marrow blast >15% has a poor NPV for predicting relapse.