Aditya Tedjaseputra , Sukanya Roy , Kay Htun , Danielle Oh , Zoe McQuilten , Paul Yeh , Ashwini Bennett , Michael Sze Yuan Low , Sanjeev Chunilal , Erica M. Wood , Jake Shortt
{"title":"在接受强化诱导和米哚妥林治疗的FLT3突变急性髓性白血病患者中,第21天的骨髓检查结果不能正确指定残留白血病:一项以形态学为重点的研究","authors":"Aditya Tedjaseputra , Sukanya Roy , Kay Htun , Danielle Oh , Zoe McQuilten , Paul Yeh , Ashwini Bennett , Michael Sze Yuan Low , Sanjeev Chunilal , Erica M. Wood , Jake Shortt","doi":"10.1016/j.pathol.2024.01.004","DOIUrl":null,"url":null,"abstract":"<div><p>Early induction response assessment with day-21 bone marrow (D21-BM) is commonly performed in patients with <em>FLT3</em>-mutated acute myeloid leukaemia (AML), where detection of residual leukaemia (RL; blasts ≥5%) typically results in the administration of a second induction course. However, whether D21-BM results predict for RL at the end of first induction has not been systematically assessed.</p><p>This study evaluates the predictive role of D21-BM morphology in detecting RL following first induction.</p><p>Between August 2018 and March 2022, all patients with <em>FLT3</em>-AML receiving 7+3 plus midostaurin, with D21-BM performed, were identified. Correlation between D21-BM morphology vs D21-BM ancillary flow/molecular results, as well as vs D28-BM end of first induction response, were retrospectively reviewed. Subsequently, D21-BMs were subjected to anonymised morphological re-assessments by independent haematopathologists (total in triplicate per patient).</p><p>Of nine patients included in this study, three (33%) were designated to have RL at D21-BM, all of whom entered complete remission at D28-BM. Furthermore, only low-level measurable residual disease was detected in all three cases by flow or molecular methods at D21-BM, hence none proceeded to a second induction. Independent re-evaluations of these cases failed to correctly reassign D21-BM responses, yielding a final false positive rate of 33%.</p><p>In summary, based on morphology alone, D21-BM assessment following 7+3 intensive induction plus midostaurin for <em>FLT3</em>-AML incorrectly designates RL in some patients; thus correlating with associated flow and molecular results is essential before concluding RL following first induction. Where remission status is unclear, repeat D28-BMs should be performed.</p></div>","PeriodicalId":19915,"journal":{"name":"Pathology","volume":null,"pages":null},"PeriodicalIF":3.6000,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Day-21 bone marrow findings incorrectly designate residual leukaemia in FLT3-mutated acute myeloid leukaemia treated with intensive induction plus midostaurin: a morphology-focused study\",\"authors\":\"Aditya Tedjaseputra , Sukanya Roy , Kay Htun , Danielle Oh , Zoe McQuilten , Paul Yeh , Ashwini Bennett , Michael Sze Yuan Low , Sanjeev Chunilal , Erica M. Wood , Jake Shortt\",\"doi\":\"10.1016/j.pathol.2024.01.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p>Early induction response assessment with day-21 bone marrow (D21-BM) is commonly performed in patients with <em>FLT3</em>-mutated acute myeloid leukaemia (AML), where detection of residual leukaemia (RL; blasts ≥5%) typically results in the administration of a second induction course. However, whether D21-BM results predict for RL at the end of first induction has not been systematically assessed.</p><p>This study evaluates the predictive role of D21-BM morphology in detecting RL following first induction.</p><p>Between August 2018 and March 2022, all patients with <em>FLT3</em>-AML receiving 7+3 plus midostaurin, with D21-BM performed, were identified. Correlation between D21-BM morphology vs D21-BM ancillary flow/molecular results, as well as vs D28-BM end of first induction response, were retrospectively reviewed. Subsequently, D21-BMs were subjected to anonymised morphological re-assessments by independent haematopathologists (total in triplicate per patient).</p><p>Of nine patients included in this study, three (33%) were designated to have RL at D21-BM, all of whom entered complete remission at D28-BM. Furthermore, only low-level measurable residual disease was detected in all three cases by flow or molecular methods at D21-BM, hence none proceeded to a second induction. Independent re-evaluations of these cases failed to correctly reassign D21-BM responses, yielding a final false positive rate of 33%.</p><p>In summary, based on morphology alone, D21-BM assessment following 7+3 intensive induction plus midostaurin for <em>FLT3</em>-AML incorrectly designates RL in some patients; thus correlating with associated flow and molecular results is essential before concluding RL following first induction. Where remission status is unclear, repeat D28-BMs should be performed.</p></div>\",\"PeriodicalId\":19915,\"journal\":{\"name\":\"Pathology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2024-03-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pathology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0031302524000850\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PATHOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pathology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0031302524000850","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PATHOLOGY","Score":null,"Total":0}
Day-21 bone marrow findings incorrectly designate residual leukaemia in FLT3-mutated acute myeloid leukaemia treated with intensive induction plus midostaurin: a morphology-focused study
Early induction response assessment with day-21 bone marrow (D21-BM) is commonly performed in patients with FLT3-mutated acute myeloid leukaemia (AML), where detection of residual leukaemia (RL; blasts ≥5%) typically results in the administration of a second induction course. However, whether D21-BM results predict for RL at the end of first induction has not been systematically assessed.
This study evaluates the predictive role of D21-BM morphology in detecting RL following first induction.
Between August 2018 and March 2022, all patients with FLT3-AML receiving 7+3 plus midostaurin, with D21-BM performed, were identified. Correlation between D21-BM morphology vs D21-BM ancillary flow/molecular results, as well as vs D28-BM end of first induction response, were retrospectively reviewed. Subsequently, D21-BMs were subjected to anonymised morphological re-assessments by independent haematopathologists (total in triplicate per patient).
Of nine patients included in this study, three (33%) were designated to have RL at D21-BM, all of whom entered complete remission at D28-BM. Furthermore, only low-level measurable residual disease was detected in all three cases by flow or molecular methods at D21-BM, hence none proceeded to a second induction. Independent re-evaluations of these cases failed to correctly reassign D21-BM responses, yielding a final false positive rate of 33%.
In summary, based on morphology alone, D21-BM assessment following 7+3 intensive induction plus midostaurin for FLT3-AML incorrectly designates RL in some patients; thus correlating with associated flow and molecular results is essential before concluding RL following first induction. Where remission status is unclear, repeat D28-BMs should be performed.
期刊介绍:
Published by Elsevier from 2016
Pathology is the official journal of the Royal College of Pathologists of Australasia (RCPA). It is committed to publishing peer-reviewed, original articles related to the science of pathology in its broadest sense, including anatomical pathology, chemical pathology and biochemistry, cytopathology, experimental pathology, forensic pathology and morbid anatomy, genetics, haematology, immunology and immunopathology, microbiology and molecular pathology.