Novel Reticulocyte and Platelet Parameters Predict Clinical Outcome in Acute Myeloid Leukemia
Olukemi Esan, Christopher J Jones, Yara M Daous, Sharon Hall, James E Coad, Jeffrey A Vos. West Virginia University, Morgantown, WV
Background: The extended reticulocyte and platelet parameters are novel peripheral blood measurements which may provide insight into the investigation of anemia, thrombocytopenia and bone marrow recovery. However, their clinical utility is largely unknown. As potential measures of residual bone marrow function, the aim of this study was to determine if these extended parameters correlate with remission status, cytogenetic risk stratification and clinical outcome in acute myeloid leukemia (AML). An initial reference range study was also conducted.
Design: Whole blood samples from 171 healthy adults (M=80, F=91; ages 18 to 88) were analyzed to establish reference ranges for the following extended parameters: mean reticulocyte volume (MCVr), mean reticulocyte hemoglobin (MCHr), mean reticulocyte hemoglobin concentration (CHCr) and percent reticulated platelets (%rP). Next, extended parameters were analyzed from 40 newly diagnosed AML patients. Variations were correlated with remission status, cytogenetic stratification and clinical outcome.
Results: The reference range study showed age- and sex-specific trends. In healthy females, MCVr fluctuated with the lowest values seen in the peri-menopausal period, while MCHr remained relatively constant. In healthy males, MCVr and MCHr gradually increased with age. In both sexes, CHCr showed a slight downward trend after the age of 30. %rP was stable throughout life. Extended parameters of 40 AML patients (M=20, F=20; ages 19-78) were studied over a 17 month period. A normal MCVr at the time of diagnosis predicted superior survival over those who had an elevated MCVr (p<0.05). Patients with normal MCVr were also more likely to achieve initial remission, although this did not reach statistical significance (p = 0.09). MCHr, CHCr and %rP were higher in patients with favorable cytogenetics compared to those with unfavorable cytogenetics, therapy-related AML (t-AML) or myelodysplasia-related AML (MDR-AML) (p < 0.05). Trends toward achieving remission (p=0.06) and favorable outcome (p=0.12) were noted in patients with normal %rP.
Conclusions: Reference ranges for the extended reticulocyte and platelet parameters show age- and sex-specific trends. In our study, AML patients with a normal MCVr at the time of diagnosis predicted a better clinical outcome. In addition, MCHr, CHCr and %rP were higher in patients with favorable cytogenetics compared to those with unfavorable cytogenetics, t-AML or MDR-AML. Although these initial data suggest prognostic significance, further studies are required to determine if these novel parameters aid in the clinical management of AML.
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 241, Monday Morning