Leukocyte count as a predictor of death during remission induction in acute myeloid leukemia

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 x10(9)/ L, a value characteristically associated with "hyperleukocytosis'' (HL). In this patient cohort, a presenting leukocyte count of >= 30 x 10(9)/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.