{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T14:21:45Z","timestamp":1747146105320,"version":"3.40.5"},"reference-count":46,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,8,7]],"date-time":"2023-08-07T00:00:00Z","timestamp":1691366400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J Hematol"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The current gold standard of response assessment in patients with myelodysplastic syndromes (MDS), chronic myelomonocytic leukemia (CMML), and acute myeloid leukemia (AML) is morphologic complete remission (CR) and CR with incomplete count recovery (CRi), both of which require an invasive BM evaluation. Outside of clinical trials, BM evaluations are only performed in ~50% of patients during follow\u2010up, pinpointing a clinical need for response endpoints that do not necessitate BM assessments. We define and validate a new response type termed \u201cperipheral blood complete remission\u201d (PB\u2010CR) that can be determined from the differential blood count and clinical parameters without necessitating a BM assessment. We compared the predictive value of PB\u2010CR with morphologic CR\/CRi in 1441 non\u2010selected, consecutive patients diagnosed with MDS (<jats:italic>n<\/jats:italic>\u2009=\u2009522; 36.2%), CMML (<jats:italic>n<\/jats:italic>\u2009=\u2009132; 9.2%), or AML (<jats:italic>n<\/jats:italic>\u2009=\u2009787; 54.6%), included within the Austrian Myeloid Registry (aMYELOIDr; NCT04438889). Time\u2010to\u2010event analyses were adjusted for 17 covariates remaining in the final Cox proportional hazards (CPH) model. DeepSurv, a CPH neural network model, and permutation\u2010based feature importance were used to validate results. 1441 patients were included. Adjusted median overall survival for patients achieving PB\u2010CR was 22.8\u2009months (95%CI 18.9\u201326.2) versus 10.4\u2009months (95%CI 9.7\u201311.2) for those who did not; HR\u2009=\u20090.366 (95%CI 0.303\u20130.441; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001). Among patients achieving CR, those additionally achieving PB\u2010CR had a median adjusted OS of 32.6\u2009months (95%CI 26.2\u201349.2) versus 21.7\u2009months (95%CI 16.9\u201327.7; HR\u2009=\u20090.400 [95%CI 0.190\u20130.844; <jats:italic>p<\/jats:italic>\u2009=\u2009.0161]) for those who did not. Our deep neural network analysis\u2010based findings from a large, prospective cohort study indicate that BM evaluations solely for the purpose of identifying CR\/CRi can be omitted.<\/jats:p>","DOI":"10.1002\/ajh.27046","type":"journal-article","created":{"date-parts":[[2023,8,7]],"date-time":"2023-08-07T11:55:16Z","timestamp":1691409316000},"page":"1685-1698","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cox proportional hazards deep neural network identifies peripheral blood complete remission to be at least equivalent to morphologic complete remission in predicting outcomes of patients treated with azacitidine\u2014A prospective cohort study by the <scp>AGMT<\/scp>"],"prefix":"10.1002","volume":"98","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2790-5067","authenticated-orcid":false,"given":"Lisa","family":"Pleyer","sequence":"first","affiliation":[{"name":"Austrian Group of Medical Tumor Therapy (AGMT) Study Group  Vienna Austria"},{"name":"Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT)  Salzburg Austria"},{"name":"Cancer Cluster Salzburg (CCS)  Salzburg Austria"},{"name":"3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center Paracelsus Medical University  Salzburg Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Vaisband","sequence":"additional","affiliation":[{"name":"Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT)  Salzburg Austria"},{"name":"Cancer Cluster Salzburg (CCS)  Salzburg Austria"},{"name":"3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center Paracelsus Medical University  Salzburg Austria"},{"name":"Life &amp; Medical Sciences Institute University of Bonn  Bonn 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Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonja","family":"Heibl","sequence":"additional","affiliation":[{"name":"Austrian Group of Medical Tumor Therapy (AGMT) Study Group  Vienna Austria"},{"name":"4th Medical Department of Internal Medicine, Hematology, Internistic Oncology and Palliative Medicine Klinikum Wels\u2010Grieskirchen GmbH  Wels Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0993-4371","authenticated-orcid":false,"given":"Heinz","family":"Sill","sequence":"additional","affiliation":[{"name":"Austrian Group of Medical Tumor Therapy (AGMT) Study Group  Vienna Austria"},{"name":"Division of Hematology Medical University of Graz  Graz Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Girschikofsky","sequence":"additional","affiliation":[{"name":"Austrian Group of Medical Tumor Therapy (AGMT) Study Group  Vienna Austria"},{"name":"1st Medical Department, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology Ordensklinikum Linz GmbH Elisabethinen  Linz Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margarete","family":"Stampfl\u2010Mattersberger","sequence":"additional","affiliation":[{"name":"Austrian Group of Medical Tumor Therapy (AGMT) Study Group  Vienna Austria"},{"name":"Department of Internal Medicine 2 Wiener Gesundheitsverbund, Klinik Donaustadt  Vienna Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelika","family":"Pichler","sequence":"additional","affiliation":[{"name":"Austrian Group of Medical Tumor Therapy (AGMT) Study Group  Vienna Austria"},{"name":"Department of Internal Medicine, Hematology and Internal Oncology LKH Hochsteiermark  Leoben Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernd","family":"Hartmann","sequence":"additional","affiliation":[{"name":"Austrian Group of Medical Tumor Therapy (AGMT) Study Group  Vienna Austria"},{"name":"Department of Internal Medicine 2 Landeskrankenhaus Feldkirch  Feldkirch Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Petzer","sequence":"additional","affiliation":[{"name":"Austrian Group of Medical Tumor Therapy (AGMT) Study Group  Vienna Austria"},{"name":"Internal Medicine I: Medical Oncology and Hematology Ordensklinikum Linz GmbH, Barmherzige Schwestern  Linz Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Schreder","sequence":"additional","affiliation":[{"name":"Austrian Group of Medical Tumor Therapy (AGMT) Study Group  Vienna Austria"},{"name":"1st Department of Internal Medicine, Center for Oncology and Hematology Wiener Gesundheitsverbund, Klinik Ottakring  Vienna Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clemens A.","family":"Schmitt","sequence":"additional","affiliation":[{"name":"Austrian Group of Medical 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