Day 14 Bone Marrow Evaluation during Acute Myeloid Leukemia Induction in a Real-World Canadian Cohort

Abstract Introduction The 2017 National Comprehensive Cancer Network (NCCN) guidelines for Acute Myeloid Leukemia (AML) recommend performing a bone marrow aspirate (BMA) and trephine biopsy (BMTB) 14-21 days after starting induction therapy (commonly referred to as a "Day 14 [D14] marrow"). Those who do not achieve a hypoplastic marrow, with cellularity Methods Patients with AML aged 18-70 years undergoing induction therapy with standard "7+3" regimens were included. D14 cellularity was determined on BMTB and blast percentage (blast %) was assessed by morphology on BMA and BMTB. Outcomes evaluated included rates of complete remission (CR) and overall survival (OS). Results A total of 486 patients with D14 BM evaluation were included in the study. In multivariate analysis cytogenetic risk and D14 blasts Conclusions Day 14 BM evaluation is predictive of subsequent remission and overall survival. Our findings do not show a survival benefit with D14 BM driven two-cycle induction.