Rebound Thrombocytosis following Induction Chemotherapy Is an Independent Predictor of a Good Prognosis in Acute Myeloid Leukemia Patients Attaining First Complete Remission

Malkan, Ümi̇t Yavuz; Güneş, Gülsen; Işık, Aynur; Eliaçık, Eylem; Etgül, Sezgin; Aslan, Tuncay; Balaban, Muruvvet Seda; Haznedaroğlu, İbrahim C.; Demiroǧlu, Halûk; Göker, Hakan; Özcebe, Osman; Sayınalp, Nilgün; Aksu, Salih; Büyükaşık, Yahya

doi:10.1159/000369917

Cited by 14 publications

(11 citation statements)

References 27 publications

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“…27 Also, rebound thrombocytosis following induction chemotherapy is an independent predictor of a good prognosis in AML patients attaining first CR. 28 In our study, those who achieved CR after induction therapy, those who did not have fibrosis in their bone marrow biopsy, those who had Auer body in their bone marrow aspirates, and those who were classified as having favorable cytogenetic risk had statistically significantly longer overall survival time, but ECOG performance score was not found to be a prognostic factor. In addition, in our AML patients rebound thrombocytosis following induction chemotherapy was not found to be a prognostic factor either.…”

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confidence: 53%

Prognostic Factors, Survival Analysis and Cytogenetic Outcomes in Adult Patients with Acute Myeloid Leukemia: A single Center Results

Teke¹

2017

UHOD

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In this study, one hundred patients under 65 years of age, who were diagnosed with acute myeloid leukemia (AML) between June 2008 to December 2015 were evaluated retrospectively. Diagnosis of the patients were based on WHO 2008 acute leukemia diagnosis criteria. One hundred AML patients were anlayzed on the basis of gender, , hemoglobin levels <10 and ≥ 10 g/dL and ECOG performans status < 2 and ≥ 2, blast count in bone marrow (BM) <%30 and ≥%30, auer body presence, cytogenetics, CD56, CD19, CD2, CD7, Tdt expression, morphological types and treatment response. 52% was male and mean age at diagnosis was 49 ± 11.4 (18-62) years. Response to induction therapy; complete response was 53%, non-response was 16% and death during the induction phase was 31%. At the end of the study analyses, 35% of patients was in remission and 65% was dead. A multivariate Cox regression analysis revealed gender (p= 0.038, HR= 0.568, 95% CI: 0.332-0.97), lactate dehydrogenase (LDH) levels (p< 0.0001, HR= 1.00, 95% CI: 1.000-1.001), fibrinogen levels (p=0.003, HR=1.002, 95% CI: 1.001-1.004 ), BM fibrosis (p< 0.0001, HR= 4.098, 95% CI: 2.287-7.345), cytogenetic risk classification (p= 0.056, HR= 1.486, 95% CI: 0.990-2.231), fungal infection (p= 0.002, HR= 0.348, 95% CI: 0.179-0.677) as prognostic factors. Aberrant expression of CD2, CD7, CD19 and CD56 on AML cells were not a poor prognostic factor in this study. Gender, LDH levels, fibrinogen levels, cytogenetic risk classification, presence of fibrosis in BM and fungal infection was found to be independent risk factors on mortality in AML patients.Keywords: Acute myeloid leukemia, cytogenetics, complete remission, prognostic factors, overall survival ÖZET Akut Myeloid Lösemili Erişkin Hastalarda Prognostik Faktörler, Sağkalım Analizi ve Sitogenetik Sonuçlar: Tek Merkez SonuçlarıBu çalışmada, Haziran 2008 ile Aralık 2015 tarihleri arasında akut myeloid lösemi (AML) tanısı konulan, 65 yaş altı yüz hasta retrospektif olarak değerlendirildi. Hastalara 2008 Dünya Sağlık Örgütü (DSÖ) akut lösemi tanı kriterlerine göre akut lösemi tanısı , hemoglobin düzeyleri <10 ve ≥ 10 g/dL ve ECOG performans statüleri < 2 ve ≥ 2, kemik iliği blast sayısı <%30 ve ≥%30 olarak, Auer rod varlığı, sitogenetik sonuçları, CD56, CD19, CD2, CD7, Tdt ekspresyonları, morfolojik tip ve tedavi yanıtları değerlendirildi. Hastaların %52'si erkek olup, ortalama yaşları 49±11,4 (18-62) idi. İndüksiyon kemoterapisine yanıt oranları; %53 tam yanıt, %16 yanıtsız, %31 oranında indüksiyon esnasında ölüm olarak bulundu. Hastaların son durum analizinde %35'i remisyonda olup, %65'i ise kaybedilmiştir. Multivariate Cox regresyon analizine göre prognoz üzerine etkili faktörler; cinsiyet (p= 0.038, HR= 0.568, 95% CI: 0.332-0.97), laktat dehidrogenaz (LDH) düzeyleri (p< 0.0001, HR= 1.00, 95% CI: 1.000-1.001), fibrinjojen düzeyleri (p=0.003, HR= 1.002, 95% CI: 1.001-1.004), kemik iliği fbrozisi (p< 0.0001, HR= 4.098, 95% CI: 2.287-7.345), sitogenetik risk sınıflaması (p= 0.056, HR= 1.486, 95% CI: 0.990-2.231) ve fungal enfeksiyon...

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confidence: 53%

Prognostic Factors, Survival Analysis and Cytogenetic Outcomes in Adult Patients with Acute Myeloid Leukemia: A single Center Results

Teke¹

2017

UHOD

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“…He had two factors that may explain the uncontrollable increase in platelet count. First, it has been reported that up to 40% of patients suffer thrombocytosis after chemotherapy aplasia for AML . In addition, the presence of CALR mutation represents a strong stimulus for thrombopoiesis.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic thrombocytapheresis for extreme thrombocytosis after chemotherapy in essential thrombocytosis

Almeida-Dias

Garrote

Cid

et al. 2019

J of Clinical Apheresis

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Essential thrombocytosis (ET) is a chronic myeloproliferative neoplasm characterized by the presence of thrombocytosis and it can be complicated by thrombotic and/or hemorrhagic events. Treatment options include low‐dose aspirin and cytoreductive agents such as hydroxyurea. In cases of extreme thrombocytosis, therapeutic thrombocytapheresis can be a useful procedure. We present a case of a 61‐year‐old‐man previously diagnosed with CALR‐mutated ET, who develop acute myeloid leukemia. When recovering after induction chemotherapy, he developed an extreme thrombocytosis up to 2337 × 109/L regardless hydroxyurea was started. Two therapeutic trombocytapheresis were performed and anagrelide was added to cytoreductive regimen. Platelet count stabilized around 570 × 109/L. Both procedures were performed with the Spectra Optia Apheresis System version 11.3 (Terumo BCT) and we decided to use a higher collection preference and lower collection speed than manufacturer's recommendations. Platelet count decreased from 2380 × 109/L to 1035 × 109/L in the first procedure and from 1813 × 109/L to 768 × 109 in the second procedure. Platelet collection efficiency was calculated to be 110.3% and 86.1% in the first and second thrombocytapheresis, respectively. Therapeutic thrombocytapheresis with Spectra Optia is a safe and efficient therapy to treat patients with primary thrombocytosis while effect of cytoreductive agents is attained. Platelet collection efficiency was calculated to be higher than previously reported. We suggest that changes in technical parameters such as a deeper aspiration point and/or lower collection speed may increase procedure's efficiency.

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“…In recent years, several studies have shown a negative correlation between platelet count and OS before treatment, which can be used as an independent predictor of AML prognosis [25][26][27][28][29][30] . Other factors related to initial platelets, including rebound thrombocytosis, platelet production, and platelet recovery time after platelet induction chemotherapy, are independent prognostic predictors of AML or acute lymphocytic leukemia (ALL) Index [31][32][33] .…”

Section: Discussionmentioning

confidence: 99%

Effect of MYH10 Variant on Acute Leukemia with Low Platelet Count Prognosis

Xiao¹,

Lin²,

Lin³

et al. 2021

Preprint

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Background: Acute myeloid leukemia (AML) is a blood disorder characterized by abnormal white blood cell count, anemia, or abnormal platelet count. It is associated with molecular genetic changes. While platelet counts vary at first diagnosis，platelets recover after chemotherapy. Objectives:This study aimed to; (1) Investigate whether the platelet count and genotype at first diagnosis are related to chemotherapy and their significance on chemotherapy prognosis; (2) Determine whether newly diagnosed patients with low platelet count have a poor prognosis and if it can be used as a separate prognostic predictor; (3) Determine whether the mutation genotype affects platelet count and its prognosis at first diagnosis. Methods: A retrospective chart review of 301 AML patients was conducted. Univariate, multivariate unconditional Logistic regression and Cox regression analyses were also conducted. Bioinformatics technology was used to extract the GSE12662 data set from the GEO database to analyze differentially expressed genes in AML patients. Besides, biological functions, pathways, proteins, and prognosis were assessed. Conclusion: Increased platelet count in AML patients after chemotherapy was an independent risk factor affecting complete remission. The platelet count also had some guiding significance for evaluating the sensitivity of patients to chemotherapy. MYH10 causes thrombocytopenia in acute myeloid leukemia via RUNX1 gene alteration and influence of prognostic factors. MYH10 variant detection improves the identification of AML molecular characteristics and its prognostic impact on AML, helping in the response analysis to chemotherapeutic agents and further treatment decisions.

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Rebound Thrombocytosis following Induction Chemotherapy Is an Independent Predictor of a Good Prognosis in Acute Myeloid Leukemia Patients Attaining First Complete Remission

Cited by 14 publications

References 27 publications

Prognostic Factors, Survival Analysis and Cytogenetic Outcomes in Adult Patients with Acute Myeloid Leukemia: A single Center Results

Prognostic Factors, Survival Analysis and Cytogenetic Outcomes in Adult Patients with Acute Myeloid Leukemia: A single Center Results

Therapeutic thrombocytapheresis for extreme thrombocytosis after chemotherapy in essential thrombocytosis

Effect of MYH10 Variant on Acute Leukemia with Low Platelet Count Prognosis

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