We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
AML-430: Utility of End-of-Induction Bone Marrow Biopsy in APL Patients Treated with ATRA/ATO Regimen.
- Authors
Dunn-Valadez, Sydney; Bathini, Srilakshmi; Purdy, Kathleen; Bachiashvili, Kimo; Bhatia, Ravi; Jamy, Omer; Rangaraju, Sravanti; Mehta, Amitkumar; Godby, Kelly; Goyal, Gaurav; Worth, Sarah; Oliver, Josh; Mikhail, Fady; Choi, John; Morlote, Diana; Reddy, Vishnu; Vachhani, Pankit
- Abstract
Significant variations exist related to end-of-induction (EOI) practices in APL management. These include fixed dose/duration ATRA/ATO vs continuation of ATRA/ATO until hematologic complete remission (CR) and performance vs omission of EOI bone marrow biopsy (BMBx) to confirm CR. These variations arise from the original protocols (notably, APL0406), as well as ELN-2019 and NCCN-2020 guidelines. To assess utility of EOI BMBx morphologic findings in APL patients treated with a 28-day ATRA/ATO induction regimen. Patients ≥ 18 years treated for APL with ATRA/ATO ± cytoreductive agent at a tertiary center from 12/2012 to 03/2020 were identified. Patients who received >30 doses of ATO or those who died in the first 4 weeks of treatment were excluded. Demographics, hematologic parameters, treatment details, and BMBx results were collected. Time-to-event endpoints were calculated from day 1 of ATO. Sixty-one patients (42 low/intermediate-risk, 19 high-risk) were included in the study. Median age at diagnosis was 51 years (21–81 years); 47 (77%) were Caucasian. No low/intermediate-risk APL patients received gemtuzumab ozogamicin (GO); 2 received anthracycline. Five high-risk APL patients received GO; 10 received anthracycline. Median time-to-dose 28 ± 2 of ATO was 28 days (27–40). Day 28 hematologic parameters showed that 38 (62.3%) patients had ANC <1,000/µL, 14 (23%) had platelets <100,000/µL, and 7 (11.5%) had both. ANC (780/µL vs 1550/µL; p=0.03) and platelets (180/µL vs 247/µL; p=0.56) were higher for patients who received GO/anthracycline vs neither. On the day of ATO dose 28 ± 2, 39 (63.9%) patients had ANC <1,000/µL, 12 (19.7%) had platelets <100,000/µL, and 7 (11.5%) had both. Fifty-one patients underwent EOI-BMBx. Median time to EOI-BMBx was 43 days (32–59 days). Forty-nine (96%) showed no morphologic evidence of APL; the remaining two (4%) were equivocal. Median time to follow-up or death was 991 days (63–2,300 days). During this period, no patients relapsed. Two patients died secondary to complications of APL following EOI. Estimated 2-year overall survival rate was 95%. A 28-dose fixed ATO-containing ATRA/ATO regimen delivers excellent outcomes. Our data suggest that EOI-BMBx can be safely omitted, irrespective of hematologic parameters.
- Publication
Clinical Lymphoma, Myeloma & Leukemia, 2021, Vol 21, pS311
- ISSN
2152-2650
- Publication type
Article
- DOI
10.1016/S2152-2650(21)01736-5