Early Fluorescence in situ Hybridization Assessment during Acute Myeloid Leukemia Induction Chemotherapy Acta Haematologica Acta Haematol 2018;139:171–175
Date
03/29/2018Abstract
Induction chemotherapy with continuous infusion cytarabine and an anthracycline (‘7&3’) is the standard up-front therapy for adults with acute myeloid leukemia (AML). Fourteen days after initiation of therapy, bone marrow sampling and analysis is performed to determine the necessity for a second cycle of induction chemotherapy prior to hematopoietic recovery. Interpretation of this sample is based on morphologic estimation of myeloblast content. The clinical significance of persistent cytogenetic abnormalities as detected by fluorescence in situ hybridization (FISH) at this time point is unknown. We performed a retrospective review of 112 previously untreated adult patients with de novo AML, 50 of whom had cytogenetic abnormalities detected by FISH at diagnosis. Patients whose disease was classified as favorable or intermediate risk by ELN criteria were more likely to convert to FISH-negativity by the mid-cycle bone marrow evaluation (p = 0.005). Furthermore, conversion to FISH-negativity at this time-point correlated with morphologically undetectable myeloblasts (82% vs. 36%, p = 0.002) and with achievement of complete remission (94% vs. 67%, p = 0.031). We conclude that the application of FISH-testing to the mid-cycle bone marrow evaluation may have clinical utility in predicting response to induction chemotherapy and should be prospectively evaluated.
Author List
Schneidewend R · Hosking P · Brazauskas R · Peterson J · Beaudin C · Michaelis L · Atallah E · Hari P · Carlson KAuthor
Karen-Sue B. Carlson MD, PhD Associate Professor in the Medicine department at Medical College of WisconsinView Online