Leukocyte count as a predictor of death during remission induction in acute myeloid leukemia |
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Authors: | Greenwood M J Seftel M D Richardson C Barbaric D Barnett M J Bruyere H Forrest D L Horsman D E Smith C Song K Sutherland H J Toze C L Nevill T J Nantel S H Hogge D E |
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Affiliation: | a The Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology and Hematopathology, Vancouver General Hospital, BC Cancer Agency and the University of British Columbia, Vancouver, BC, Canada |
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Abstract: | Acute myeloid leukemia (AML) presenting with a high leukocyte count has been associated with an increase in induction mortality and poor results in a number of other survival measures. However, the level at which an elevated leukocyte count has prognostic significance in AML remains unclear. In this report on a series of 375 adult (non-M3) AML patients undergoing induction chemotherapy at a single institution, leukocyte count analyzed as a continuous variable is shown to be a better predictor of induction death (ID) and overall survival (OS) than a leukocyte count of ≥100×109/L, a value characteristically associated with “hyperleukocytosis” (HL). In this patient cohort, a presenting leukocyte count of ≥30×109/L had high sensitivity and specificity for predicting ID, and both performance status (PS) and leukocyte count more accurately predicted for ID than age. Considering these parameters in newly-diagnosed AML patients may facilitate the development of strategies for reducing induction mortality. |
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Keywords: | Acute myeloid leukemia induction mortality leukocyte count |
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