Clinical features and prognosis of acute myeloid leukemia patients with incomplete blood recovery at the time of achieving morphologic complete remission / 白血病·淋巴瘤

ABSTRACT

Objective To analyze the clinical features and prognosis of acute myeloid leukemia (AML) patients with incomplete blood recovery [platelet count (Plt) < 100 ×109/L or absolute neutrophil count (ANC)<1.0×109/L] at the first time of achieving morphologic complete remission(CR). Methods The clinical data of 302 AML patients (non-M3) who were treated at the First Affiliated Hospital of Zhengzhou University from January 2010 to September 2015 were retrospectively reviewed. They were divided into CR group (Plt≥100×109/L and ANC≥1.0×109/L) and CR with incomplete blood recovery group (Plt<100×109/L or ANC<1.0 ×109/L) according to the condition of blood count at the first time of achieving morphologic CR. The clinical features and prognostic differences between the two groups were compared, and univariate analysis and mutivariate analysis were performed to compare the recurrence and survival of AML with incomplete blood recovery. Results Two hundred and sixteen (71.5%) patients were in CR group and 86 (28.5%) were in CR with incomplete blood recovery group. There was no statistically difference between the two groups in terms of age, high white blood cell, peripheral blasts ratio, France-American-Britain (FAB) type, cytogenetic risk classification and FLT3-ITD/NPM1 gene mutation (all P>0.05). Bone marrow blasts before therapy and the proportion of bone marrow CR in the first course of chemotherapy in CR group were higher than those in CR with incomplete blood recovery group (both P< 0.05), and the proportion of minimal residual disease (MRD) positive patients was lower in CR group (P=0.004). Bone marrow proliferation at the time of achieving morphologic CR was more active in CR group (P=0.001). The 3-year relapse rate in CR group was lower than that in CR with incomplete blood recovery group (P= 0.003), and overall survival (OS) rate and disease-free survival (DFS) rate were higher than those in CR with incomplete blood recovery group (both P< 0.05). Multivariate prognostic analysis for relapse, OS rate and DFS rate showed that high risk karyotype,≥2 courses of induction therapy and neutrophils not recovery were independent risk factors for AML patients with incomplete blood recovery (all P>0.05). In addition, FLT3-ITD positive was an independent risk factor for OS rate(P< 0.001), and peripheral blood blasts ≥0.60 was an independent risk factor for DFS rate (P= 0.047). Conclusions AML patients with incomplete blood recovery at the first time of achieving morphologic CR have a poor prognosis. AML patients with high-risk karyotype, ≥2 courses of induction therapy, incomplete neutrophils recovery may have a worse prognosis, and they should be regarded as high-risk groups and given more aggressive treatment.