Immature Reticulocyte Fraction and Absolute Neutrophil Count as Predictor of Hemopoietic Recovery in Patients with Acute Lymphoblastic Leukemia on Remission Induction Chemotherapy

Abstract

Objective:Acute lymphoblastic leukemia (ALL) encompasses a group of lymphoid neoplasms that are more common in children and arise from B-and T-lineage lymphoid precursor cells. The immature reticulocyte fraction (IRF), a new routine parameter in hematology analyzers, can give an indication of hemopoietic recovery like absolute neutrophil count (ANC). The purpose of this study was to evaluate IRF in excess of 5% was considered as IRF recovery.Materials and Methods:In this descriptive study, 2.5 to 3 mL of EDTA blood of 45 ALL patients undergoing the remission induction phase of their treatment was sampled and analyzed with a Sysmex XE-5000 on day 1 and every second day thereafter until the day of recovery. ANC of >0.5x109/L on the day corresponding to the first of the three consecutive counts was considered as the day of ANC recovery. IRF recovery was an IRF in excess of 5%.Results:The mean age of the patients was 12.04±5.30 years; 25 patients (55.6%) were male and 20 patients (44.4%) were female. On day 1 of induction remission, the mean IRF value was 9.68±1.41, while the mean ANC value was 0.077±0.061. Mean recovery day for IRF was 11.84±7.44 and mean recovery day for ANC was 17.67±8.77 (two- tailed p-value <0.0001 with 95% confidence interval). By day 28, out of 45 patients 36 (80%) showed ANC recovery, while 41 (91%) showed IRF recovery. The remaining patients who had not shown recovery by day 28 were further followed up and all of them showed recovery of both parameters by day 39.Conclusion:This study concluded that postinduction bone marrow hemopoietic recovery was earlier by IRF than ANC in children with ALL on chemotherapy.

Time of Attainment of Clinical Remission and Peripheral Blood Count Recovery during Induction Chemotherapy for Childhood Acute Lymphoblastic Leukemia

“…4 Rauf et al also found 20% of patients not recovered at the end of induction. 15 This study found average duration to achieve clinical remission was longer in HR group. This may be due to high tumor load causing massive organomegaly taken more time to resolve.…”

Cytokinetic parameters of erythropoiesis under normal health conditions and during the development of acute lymphoblastic and acute myeloblastic leukemia

“…According to the literature data, the immature data, the immature reticulocyte fraction (IRF) may be termed as the red cell equivalent of the "left shift" typically associated with neutrophilic white cells [2]. The IRF recovery in patients with acute leukemia after chemotherapy showing bone marrow hematopoietic recovery earlier than absolute neutrophil count [3].…”

“…Reticulocyte counts can provide useful information about bone marrow erythropoietic activity, the rate of reticulocyte delivery from the bone marrow into peripheral blood, and the rate of reticulocyte maturation. These parameters can be really important to studying the compensatory-adaptive reactions accompanying the development of malignant proliferation in the blood system such as leukemia and to the prediction of hemopoietic recovery in patients [2,3].…”

Usefulness of baseline immature reticulocyte fraction to mature reticulocyte fraction ratio (IMR) as A prognostic predictor for patients with small cell lung cancer

“…It is easier to obtain, can be put into clinical use immediately, does not require long-term verification such as scientific research experiments, and greatly reduces the cost of testing and many other advantages. IRF refers to the proportion of young reticulocytes, which reflects erythropoietic activity and is the first sign of blood recovery [ 35 , 36 ]. The quantitative and morphological characteristics of reticulocytes are associated with the aggressiveness of the tumor and the more severe clinical status of the patient [ 37 ].…”