Early recovery of the platelet count after decitabine-based induction chemotherapy is a prognostic marker of superior response in elderly patients with newly diagnosed acute myeloid leukaemia
Abstract Background Definite prognostic clinical factors of benefit for decitabine-based induction chemotherapy in elderly patients newly diagnosed with acute myeloid leukaemia (AML) are not identified. This study was designed to explore the potential biomarker, especially regeneration of haematopoi...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-12-01
|
| Series: | BMC Cancer |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12885-018-5160-5 |
| _version_ | 1818541914524221440 |
|---|---|
| author | Jiayu Huang Huihui Zhao Ming Hong Han Zhu Yu Zhu Yun Lian Shan Li Jianyong Li Sixuan Qian |
| author_facet | Jiayu Huang Huihui Zhao Ming Hong Han Zhu Yu Zhu Yun Lian Shan Li Jianyong Li Sixuan Qian |
| author_sort | Jiayu Huang |
| collection | DOAJ |
| description | Abstract Background Definite prognostic clinical factors of benefit for decitabine-based induction chemotherapy in elderly patients newly diagnosed with acute myeloid leukaemia (AML) are not identified. This study was designed to explore the potential biomarker, especially regeneration of haematopoiesis, of treatment response and survival in elderly patients with newly diagnosed AML. Method We analysed the clinical data of 117 elderly AML patients who were treated with a decitabine dose of 15 mg/m2 for 5 days, granulocyte colony-stimulating factor of 300 μg/d for priming, plus cytarabine 10 mg/m2 q12h for 7 days and aclarubicin 10 mg/d for 4 days (D-CAG). Results After initial induction chemotherapy, the overall response rate and complete remission (CR) were 71.8% and 58.1%, respectively. Patients responding to the D-CAG regimen achieved higher platelet counts on day 14 after initial treatment (p < 0.001). Median counts were 59.5 × 109/L in the CR group, 37 × 109/L in the partial remission group and 28 × 109/L in the non-responsive group. We then classified patients into those who achieved platelet counts≥60 × 109/L or 100 × 109/L on day 14 after D-CAG vs. those who did not. Platelet counts≥60 × 109/L or 100 × 109/L on day 14 were significantly associated with superior CR, overall survival and disease-free survival (80.9% vs. 45.3% p < 0.001,16.5 vs. 9.1 months p = 0.009 and 16.3 vs. 7.4 months p = 0.024; 85.2% vs. 50% p = 0.001, 31 vs. 10.1 months p = 0.003 and 16.9 vs. 8.9 months p = 0.006). Multivariate analysis confirmed that poor cytogenetics (p = 0.010) and FLT3-ITD mutation (p = 0.007) were identified as independent factors of OS, but not platelet count (p = 0.091). However, platelet count≥100 × 109/L on day 14 was an independent prognostic factor of CR and DFS. Conclusion Platelet count recovery on day 14 after D-CAG induction chemotherapy is associated with response. Trial registration D-CAG regimen was registered on ChicTR with number 11001700. |
| first_indexed | 2024-12-11T22:15:22Z |
| format | Article |
| id | doaj.art-5d44451a39de4cfd88437df9c6d74644 |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-12-11T22:15:22Z |
| publishDate | 2018-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj.art-5d44451a39de4cfd88437df9c6d746442022-12-22T00:48:37ZengBMCBMC Cancer1471-24072018-12-0118111010.1186/s12885-018-5160-5Early recovery of the platelet count after decitabine-based induction chemotherapy is a prognostic marker of superior response in elderly patients with newly diagnosed acute myeloid leukaemiaJiayu Huang0Huihui Zhao1Ming Hong2Han Zhu3Yu Zhu4Yun Lian5Shan Li6Jianyong Li7Sixuan Qian8Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province HospitalDepartment of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province HospitalDepartment of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province HospitalDepartment of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province HospitalDepartment of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province HospitalDepartment of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province HospitalDepartment of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province HospitalDepartment of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province HospitalDepartment of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province HospitalAbstract Background Definite prognostic clinical factors of benefit for decitabine-based induction chemotherapy in elderly patients newly diagnosed with acute myeloid leukaemia (AML) are not identified. This study was designed to explore the potential biomarker, especially regeneration of haematopoiesis, of treatment response and survival in elderly patients with newly diagnosed AML. Method We analysed the clinical data of 117 elderly AML patients who were treated with a decitabine dose of 15 mg/m2 for 5 days, granulocyte colony-stimulating factor of 300 μg/d for priming, plus cytarabine 10 mg/m2 q12h for 7 days and aclarubicin 10 mg/d for 4 days (D-CAG). Results After initial induction chemotherapy, the overall response rate and complete remission (CR) were 71.8% and 58.1%, respectively. Patients responding to the D-CAG regimen achieved higher platelet counts on day 14 after initial treatment (p < 0.001). Median counts were 59.5 × 109/L in the CR group, 37 × 109/L in the partial remission group and 28 × 109/L in the non-responsive group. We then classified patients into those who achieved platelet counts≥60 × 109/L or 100 × 109/L on day 14 after D-CAG vs. those who did not. Platelet counts≥60 × 109/L or 100 × 109/L on day 14 were significantly associated with superior CR, overall survival and disease-free survival (80.9% vs. 45.3% p < 0.001,16.5 vs. 9.1 months p = 0.009 and 16.3 vs. 7.4 months p = 0.024; 85.2% vs. 50% p = 0.001, 31 vs. 10.1 months p = 0.003 and 16.9 vs. 8.9 months p = 0.006). Multivariate analysis confirmed that poor cytogenetics (p = 0.010) and FLT3-ITD mutation (p = 0.007) were identified as independent factors of OS, but not platelet count (p = 0.091). However, platelet count≥100 × 109/L on day 14 was an independent prognostic factor of CR and DFS. Conclusion Platelet count recovery on day 14 after D-CAG induction chemotherapy is associated with response. Trial registration D-CAG regimen was registered on ChicTR with number 11001700.http://link.springer.com/article/10.1186/s12885-018-5160-5Platelet recoveryPrognostic indicatorDecitabineAcute myeloid leukaemiaElderly |
| spellingShingle | Jiayu Huang Huihui Zhao Ming Hong Han Zhu Yu Zhu Yun Lian Shan Li Jianyong Li Sixuan Qian Early recovery of the platelet count after decitabine-based induction chemotherapy is a prognostic marker of superior response in elderly patients with newly diagnosed acute myeloid leukaemia BMC Cancer Platelet recovery Prognostic indicator Decitabine Acute myeloid leukaemia Elderly |
| title | Early recovery of the platelet count after decitabine-based induction chemotherapy is a prognostic marker of superior response in elderly patients with newly diagnosed acute myeloid leukaemia |
| title_full | Early recovery of the platelet count after decitabine-based induction chemotherapy is a prognostic marker of superior response in elderly patients with newly diagnosed acute myeloid leukaemia |
| title_fullStr | Early recovery of the platelet count after decitabine-based induction chemotherapy is a prognostic marker of superior response in elderly patients with newly diagnosed acute myeloid leukaemia |
| title_full_unstemmed | Early recovery of the platelet count after decitabine-based induction chemotherapy is a prognostic marker of superior response in elderly patients with newly diagnosed acute myeloid leukaemia |
| title_short | Early recovery of the platelet count after decitabine-based induction chemotherapy is a prognostic marker of superior response in elderly patients with newly diagnosed acute myeloid leukaemia |
| title_sort | early recovery of the platelet count after decitabine based induction chemotherapy is a prognostic marker of superior response in elderly patients with newly diagnosed acute myeloid leukaemia |
| topic | Platelet recovery Prognostic indicator Decitabine Acute myeloid leukaemia Elderly |
| url | http://link.springer.com/article/10.1186/s12885-018-5160-5 |
| work_keys_str_mv | AT jiayuhuang earlyrecoveryoftheplateletcountafterdecitabinebasedinductionchemotherapyisaprognosticmarkerofsuperiorresponseinelderlypatientswithnewlydiagnosedacutemyeloidleukaemia AT huihuizhao earlyrecoveryoftheplateletcountafterdecitabinebasedinductionchemotherapyisaprognosticmarkerofsuperiorresponseinelderlypatientswithnewlydiagnosedacutemyeloidleukaemia AT minghong earlyrecoveryoftheplateletcountafterdecitabinebasedinductionchemotherapyisaprognosticmarkerofsuperiorresponseinelderlypatientswithnewlydiagnosedacutemyeloidleukaemia AT hanzhu earlyrecoveryoftheplateletcountafterdecitabinebasedinductionchemotherapyisaprognosticmarkerofsuperiorresponseinelderlypatientswithnewlydiagnosedacutemyeloidleukaemia AT yuzhu earlyrecoveryoftheplateletcountafterdecitabinebasedinductionchemotherapyisaprognosticmarkerofsuperiorresponseinelderlypatientswithnewlydiagnosedacutemyeloidleukaemia AT yunlian earlyrecoveryoftheplateletcountafterdecitabinebasedinductionchemotherapyisaprognosticmarkerofsuperiorresponseinelderlypatientswithnewlydiagnosedacutemyeloidleukaemia AT shanli earlyrecoveryoftheplateletcountafterdecitabinebasedinductionchemotherapyisaprognosticmarkerofsuperiorresponseinelderlypatientswithnewlydiagnosedacutemyeloidleukaemia AT jianyongli earlyrecoveryoftheplateletcountafterdecitabinebasedinductionchemotherapyisaprognosticmarkerofsuperiorresponseinelderlypatientswithnewlydiagnosedacutemyeloidleukaemia AT sixuanqian earlyrecoveryoftheplateletcountafterdecitabinebasedinductionchemotherapyisaprognosticmarkerofsuperiorresponseinelderlypatientswithnewlydiagnosedacutemyeloidleukaemia |