The day 14 bone marrow aspirate and biopsy (D14BM) is regularly used to predict achievement of complete remission (CR) with induction chemotherapy in acute myeloid leukemia (AML), however its utility has been questioned. Clearance of peripheral blood blasts (PBB) may serve as an early measure of chemosensitivity. PBB rate of clearance (PBB-RC) was calculated for treatment-naive AML patients (n = 164) undergoing induction with an anthracycline and cytarabine (7+3) and with detectable PBB at diagnosis. PBB-RC was defined as the percentage of the absolute PBB count on the day of diagnosis that was cleared with each day of therapy, on average, until D14 or day of PBB clearance. Each 5% increase in PBB-RC approximately doubled the likelihood of D14BM clearance (OR = 1·81; 95% CI: 1·24-2·64, P < 0·005). PBB-RC was also associated with improved CR rates (OR per 5% = 1·97; 95% CI: 1·27-3·01, P < 0·005) and overall survival (OS) [hazard ratio (HR) per 5% = 0·67; 95% CI: 0·52-0·87]. African American patients had poorer OS adjusted for PBB-RC (HR = 2·18; 95% CI: 1·13-4·23), while race was not associated with D14BM or CR rate. PBB-RC during induction chemotherapy is predictive of D14BM clearance, CR, and OS, and can therefore serve as a prognostic marker for clinical outcomes in AML.

中文翻译：

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外周血母细胞清除率是急性髓细胞性白血病临床反应和预后的独立预测指标。

第14天的骨髓穿刺活检（D14BM）通常用于预测急性髓细胞性白血病（AML）中诱导化疗的完全缓解（CR）的实现，但是其实用性受到质疑。清除外周血母细胞（PBB）可以作为化学敏感性的早期指标。计算未接受过治疗的AML患者（n = 164）在接受蒽环类和阿糖胞苷（7 + 3）诱导后在诊断时可检测到的PBB的PBB清除率（PBB-RC）。PBB-RC定义为在诊断日当天平均PBB计数的百分比，该平均水平每天平均治疗，直到D14或PBB清除日为止。PBB-RC的每增加5％，D14BM清除的可能性大约增加一倍（OR = 1·81； 95％CI：1·24-2·64，P <0·005）。PBB-RC还与CR率提高（OR 5％= 1·97； 95％CI：1·27-3·01，P <0·005）和总生存期[OS] [危险比（HR）每5％= 0·67; 95％CI：0·52-0·87]。非洲裔美国人的患者经PBB-RC调整后的OS较差（HR = 2·18； 95％CI：1·13-4·23），而种族与D14BM或CR率无关。诱导化疗期间的PBB-RC可预测D14BM清除，CR和OS，因此可作为AML临床预后的预后指标。