Clinical and prognostic significance of in vivo differentiation in acute myeloid leukemia

Azra Raza, Harvey Preisler, Beatrice Lampkin, Joseph Lykins, Cathy Kukla, Peter Gartside, Yasin Sheikh, Naveed Yousuf, Michael White, Maurice Barcos, John Bennett, George Browman, Jack Goldberg, Hans Grunwald, Richard Larson, James Vardiman, Ralph Vogler

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9 Scopus citations


Bromodeoxyuridine (BrdU) was administered to 86 newly diagnosed patients with standard risk acute myeloid leukemia (AML) prior to starting induction therapy and the labeling index (LI), durations of S‐phase (Ts), and the cell cycle (Tc) of myeloblasts were determined. Induction therapy with cytosine arabinoside and daunomycin was subsequently started. Bone marrow biopsies were obtained on days 6 and 17 and weekly thereafter, and were treated with a monoclonal anti‐BrdU antibody to determine the fate of cells labeled on day 0 by BrdU. BrdU labeled granulocytes indicating the presence of in vivo differentiation (Diff+) were identified in 48 patients ranging from 1+ (1–10 labeled cells) to 4+ (greater than 31 labeled granulocytes). When compared to 38 differentiation negative (Diff‐) patients, Diff+ group had longer Ts (14.5 hr vs. 10.95 hr, P = 0.015) and Tc (59.7 hr vs. 41.7 hr, P = 0.017). Remission duration was significantly longer (no median) for 3–4+ Diff+ as compared to Diff‐ (median = 220 days) patients (Wilcoxon P = 0.04). We conclude that the detection of in vivo differentiation in AML patients indicates a favorable long‐term prognosis either due to the presence of a substantial amount of normal residual hematopoiesis prior to starting induction therapy or due to the ability of leukemic cells to undergo differentiation. © 1993 Wiley‐Liss, Inc.

Original languageEnglish
Pages (from-to)147-157
Number of pages11
JournalAmerican Journal of Hematology
Issue number2
StatePublished - Feb 1993
Externally publishedYes


  • bone marrow biopsies
  • bromodeoxyuridine
  • induction therapy


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