Response Criteria to Induction Chemotherapy as a Prognostic Factor for Adult Acute Myeloid Leukemia

Background: This is a retrospective study done at National Cancer Institute (NCI), Cairo University, included 99 de novo AML patients who received induction chemotherapy in the period between 1st of January, 2009, and 31st of December, 2009. In this study, we investigated the impact of different categories of response at day 28 after start of induction chemotherapy on the overall survival (OS), relapse free survival (RFS), and events free survival (EFS). For many years, response to induction therapy in acute myeloid leukemia (AML) was classified as complete remission (CR) or no response. In 2003, less stringent response categories were introduced, For example, CR with incomplete platelet recovery (CRp). CR with incomplete neutrophil recovery (CRn). Also, little information is available regarding morphologic leukemia free state (MLFS) in which the marrow has less than 5% blasts, without hematologic recovery. Patients and Methods: Our practice led us to retrospectively examine the effect of response criteria to induction chemotherapy at day 28 on outcome in newly diagnosed AML, by using the data from 99 de novo AML patients, received induction chemotherapy in the National Cancer Institute of Egypt (NCI), in the period between 1st of January, 2009, and 31st of December, 2009. Results: CR showed statistically significant improvement of overall survival (OS) in relation to CRp, MLFS, and resistant disease, while, CR wasn’t statistically significant in relation to CRn. The latter showed statistically significant improvement of OS in relation to MLFS, and resistant disease. CRp wasn’t statistically significant in relation to MLFS, and resistant disease. Also, MLFS wasn’t statistically significant in relation to resistant disease. Conclusion: Our data indicated that complete remission (CR) at day 28 from start of induction chemotherapy of unique clinical significance, and should be reported as separate response in trials of newly diagnosed AML. Nonetheless, our finding might validate CR with incomplete neutrophil recovery