Evaluation of bone marrow aspirates in patients with acute myeloid leukemia at day 14 of induction therapy

Diagnostic Pathology

Rodrigo D Portugal¹  Marcio Nucci¹  José Carlos Morais¹  Wolmar Pulcheri¹  Monique M Loureiro¹  João Tadeu D Souto Filho² 

[1] University Hospital, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 255, Sala 4A 12, Rio de Janeiro 22251-030, RJ, Brazil;Instituto Federal de Educação, Ciência e Tecnologia Fluminense, Campos dos Goytacazes, RJ, Brazil

关键词: D14;    Blasts counting;    Bone marrow;    Acute myeloid leukemia;   

Others  :  1225961
DOI  :  10.1186/s13000-015-0365-2

 received in 2015-06-08, accepted in 2015-07-15,  发布年份 2015

【 摘 要 】

Background

Early assessment of response to chemotherapy in acute myeloid leukemia may be performed by examining bone marrow aspirate (BMA) or biopsy (BMB); a hypocellular bone marrow sample indicates adequate anti-leukemic activity. We sought to evaluate the quantitative and qualitative assessment of BMA performed on day 14 (D14) of chemotherapy, to verify the inter-observer agreement, to compare the results of BMA and BMB, and to evaluate the impact of D14 blast clearance on the overall survival (OS).

Methods

A total of 107 patients who received standard induction chemotherapy and had bone marrow samples were included. BMA evaluation was performed by two observers using two methods: quantitative assessment and a qualitative (Likert) scale. ROC curves were obtained correlating the BMA quantification of blasts and the qualitative scale, by both observers, with BMB result as gold-standard.

Results

There was a significant agreement between the two observers in both the qualitative and quantitative assessments (K _w  = 0.737, p < 0.001, and r _s  = 0.798, p < 0.001; ICC = 0.836, p < 0.001, respectively). The areas under the curve (AUC) were 0.924 and 0.946 for observer 1 and 0.867 and 0.870 for observer 2 for assessments of the percentage of blasts and qualitative scale, respectively. The best cutoff for blast percentage in BMA was 6 % and 7 % for observers 1 and 2, respectively. A similar analysis for the qualitative scale showed the best cutoff as “probably infiltrated”. Patients who attained higher grades of cytoreduction on D14 had better OS.

Conclusions

Evaluation of D14 BMA using both methods had a significant agreement with BMB and between observers, identifying a population of patients with poor outcome.

【 授权许可】

   
2015 Filho et al.

【 图 表 】

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