White blood cell count nadir to zero following intensive chemotherapy as a predictive factor for patients with acute myeloid leukemia

Abstract

Predictors for response to intensive therapy in AML have focused on baseline factors: percent leukemic blasts in marrow, cytogenetic/molecular genetic abnormalities, and presence of secondary AML. Non-baseline dynamic factors, occurring after induction but before response, may be useful for decisions related to salvage chemotherapy. We hypothesized white blood cell (WBC) count nadir after induction may be a real time indicator of treatment efficacy. We also examined whether time to stem cell transplant (SCT) or baseline molecular genetic abnormalities are associated with a low nadir. Data showed WBC nadir = 0 was a negative predictor for response to intensive induction and was correlated with reduced overall survival and progression free survival. Patients with WBC nadir = 0 did not have a significantly longer time to SCT, and none of the mutations increased the likelihood of reaching WBC nadir = 0. WBC nadir may be a useful real-time monitor in AML patients receiving intensive induction chemotherapy.

Keywords:

• Acute myeloid leukemia
• predictive factors
• WBC nadir
• induction chemotherapy
• stem cell transplant
• overall survival
• progression free survival

Acknowledgments

DAP is supported by the Robert H. Allen MD Chair in Hematology Research and the Leukemia and Lymphoma Society’s Career Development Award

Authors’ contributions

JF and DAP conceived of the project, reviewed the data and performed the analysis. GB performed the analysis. All authors reviewed the results and approved the manuscript.

Disclosure statement

We have no conflicts of interest to disclose.

Data availability statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.