What would your approach be to a patient with AML who is s/p induction with D30+ marrow demonstrating low blast percentage, say <5%, but otherwise hypoplastic with peripheral counts having persistent neutropenia (ANC<500) and thrombocytopenia (Plt<50k)? Based on remission criteria, this would technically be refractory AML. Would you monitor until peripheral counts recover and reassess with a bone marrow, or would you move forward with additional induction/treatment?
Based on the information you provided this would most accurately be described as morphologic leukemia-free state (if blasts really <5%). In addition, if there are other markers of this patient's AML (e.g. NPM1 mutation, cytogenetic abnormality), it would be exceedingly helpful to assess these at this juncture. Regardless of the exact title, I think the best course of action would be to give an additional 1-2 weeks to allow for count recovery. If still no count recovery, remarrowing would be helpful. I would advise against reinduction right away given that the field is moving more towards refractory disease treatment with an alternative regimen (e.g. hypomethylating agent+venetoclax) rather than giving more chemotherapy
