Evaluation of post-chemotherapy hematopoietic recovery by Immature Reticulocyte Fraction in patients with acute leukaemia

Abstract

Introduction: Immature reticulocyte fraction is a new routine parameter in the hematology analyzer can give the idea of the earliest morphologic change of bone marrow recovery after chemotherapy. In this study was carried out in the Department of Hematology and BMT center of First Central Hospital of Mongolia from January 2019 to January 2020 evaluate the bone marrow recovery in adults with acute leukemia and also auto-BMT transplanted patients by automated reticulocyte analysis. Total seventeen patients were enrolled in this study on the remission induction phase. All patients were between 19-63 years age range with a mean age of 40±13. 82.3% of patients showed early immature reticulocyte fraction (IRF) recovery and late recovery occurred in 5.8%. 11.7% of cases the recovery of ANC and IRF were on the same day. Purpose: To evaluate IRF as an earlier predictor of bone marrow recovery than absolute neutrophil count (ANC) in patients with acute leukemia on induction chemotherapy. Materials and methods: Total 17 patients with newly diagnosed acute myeloblastic leukemia (AML) and acute lymphoblastic leukemia (ALL) were enrolled in this study on the remission induction phase. The values of IRF and ANC were compared before and after chemotherapy, and bone marrow recovery was evaluated. IRF was done in 17 patients in Sysmex XN2000 hematology analyzer, and ANC was calculated using the following formula: [ANC = WBC x (segments /% / + band /% /) / 100].The analysis was done by Stata 12.0 by applying appropriate formula. Bone marrow recovery was evaluated by Mean, Median, Paired t-test. p-value<0.05 was considered statistically significant. Results: Mean age was 40±13 years, nine (59.9%) patients were male and eight (47.06%) patients were female. The mean recovery day for IRF was 14.5±4.1, while that for ANC was 32.05±25.2. It was on the same day in two (11.7%) cases; late recovery occurred one (5.8%) case. Thus, the earlier recovery was 14 (82.3%) cases. Conclusion: IRF can predict bone marrow recovery earlier than ANC count. IRF can serve as an additional parameter in patients who are in need of evaluation of bone marrow recovery after chemotherapy.