Mathematical Models for the Influence of Cytarabine on White Blood Cell Dynamics in Acute Myeloid Leukemia

Abstract

AbstractWe investigate the personalisation and prediction accuracy of mathematical models for white blood cell (WBC) count dynamics during consolidation treatment using intermediate or high-dose cytarabine (Ara-C) in acute myeloid leukemia (AML). Ara-C is the clinically most relevant cytotoxic agent for AML treatment.We extend the gold-standard model of myelosuppression and a pharmacokinetic model of Ara-C with different hypotheses of Ara-C’s pharmacodynamic effects. We cross-validate 12 mathematical models using dense WBC count measurements from 23 AML patients. Surprisingly, the prediction accuracies are similarly good despite different modelling hypotheses. Therefore, we compare average clinical and calculated WBC recovery times for different Ara-C schedules as a successful methodology for model discrimination. As a result, a new hypothesis of a secondary pharmacodynamic effect on the proliferation rate seems plausible. Furthermore, we demonstrate how personalized predictions of the impact of treatment timing on subsequent nadir values could be used for clinical decision support.Author summaryThe major obstacle in accurately predicting the outcome of a medical therapy is the vast variation in individual response patterns. It concerns both the subjective experience of the patient and the objectively measurable achievement of a clinical remission with restoration of normal blood counts. Here, we address acute myeloid leukemia (AML)-chemotherapy using cytarabine (Ara-C) as this drug is this most important component of AML-treatment. In addition to the wide spectrum of genetic aberrations involved in pathogenesis leading to variations in patient response patterns, another facet of personalised medicine awaits exploration of its full potential: a systematic, mathematical approach to understand and manipulate the dynamics of relevant biomarkers. We use personalised mathematical models to describe and predict white blood cell (WBC) counts during AML consolidation treatment. We analyse why and to what extent low WBC counts, a serious adverse event during therapy, occur. In a comprehensive approach we investigate published models, compare them with our extended models and outline the impact of modelling assumptions and varying chemotherapy schedules on prediction accuracy and model discrimination. Our numerical results confirm the clinical finding that a newly proposed schedule is superior with respect to WBC recovery and shed new light on the reasons why.