Prognostic value of platelet recovery degree before and after achieving minimal residual disease negative complete remission in acute myeloid leukemia patients

• Published in: BMC cancer Vol. 20; no. 1; pp. 732 - 8
• Main Authors: Wang, Yang, Wang, Hua, Wang, Weida, Liu, Wenjian, Liu, Nawei, Liu, Shuang, Lu, Yue
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 05.08.2020; BioMed Central; BMC
• Subjects: Acute myelocytic leukemia; Acute myeloid leukemia; Acute myeloid leukemia (AML); Adolescent; Adult; Aged; Analysis; Blood Platelets; Bone marrow; Bone Marrow - drug effects; Care and treatment; Chemotherapy; Child; Child, Preschool; Complete remission (CR); Confidence intervals; Cytogenetics; Female; Humans; Leukemia; Leukemia, Myeloid, Acute - blood; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - mortality; Male; Medical prognosis; Middle Aged; Minimal residual disease; Multivariate Analysis; Myeloid leukemia; Neoplasm, Residual; Overall survival (OS); Patient outcomes; Patients; Platelet Count; Platelet recovery degree; Platelets; Prognosis; Progression free survival (PFS); Progression-Free Survival; Remission; Remission Induction; Retrospective Studies; Software; Survival analysis; Young Adult; Progression free survival (PFS); Overall survival (OS); Complete remission (CR); Platelet recovery degree; Acute myeloid leukemia (AML)
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-020-07222-4

Risk stratification and prognosis prediction of acute myeloid leukemia (AML) are largely dependent on pre-treatment information. However, post-treatment data also provides much useful information. In this retrospective study, we explored whether the level of blood count recovery before and after the first minimal residual disease (MRD) negative complete remission (CR) is relevant to clinical outcomes of AML patients. For each included patient, peripheral platelet counts were measured on the day before initial treatment (PLT ), whereas platelet peak values (PLT ) were recorded after marrow recovery following the chemotherapy course inducing the first MRD-negative CR. The difference (D ) between these two values (D  = PLT PLT ) was calculated. X-tile software was utilized to establish the optimal cut-point for D , which was expected to distinguish CR patients with different clinical outcomes. A cross validation analysis was conducted to confirm the robustness of the established cut-point. The results were further tested by a Cox multivariate analysis. The optimal cut-point of D was determined as 212 × 10 /L. Patients in high D group were observed to have a significantly better PFS (p = 0.016) and a better OS (without statistical significance, p = 0.106). Cox multivariate analysis showed that higher D was associated with longer PFS (HR = 2.894, 95% CI: 1.320-6.345, p = 0.008) and longer OS (HR = 3.077, 95% CI: 1.130-8.376, p = 0.028). Platelet recovery degree before and after achieving MRD-negative CR (D ) is a potential predictor of clinical outcomes in CR patients. Higher D value is associated with longer PFS and OS. Our findings may help to develop simple methods for AML prognosis evaluation.