Impact of Body Mass Index on Patient Outcome in Acute Myeloid Leukemia Patients Receiving Intensive Induction Therapy: A Real-World Registry Experience
Blood, vol. 138, pp. 3370
Abstract
Abstract Acute myeloid leukemia (AML) is a hematologic malignancy that is treated in medically fit patients with intensive induction chemotherapy (IT) and postremission therapy to achieve a complete and long-term remission. The incidence of obesity in the general population is steadily increasing and has been identified as a major risk factor for all-cause mortality. Despite previous studies assessing the role of obesity in AML patients undergoing IT, there is an ongoing debate on the impact of obesity on patient outcome as well as the optimal dosing strategy in obese AML patients. We conducted a retrospective registry study assessing 1677 AML patients who were treated with IT for newly diagnosed AML. The primary endpoint was overall survival (OS) while event-free survival (EFS), the rate of first complete remission (CR1), relapse/refractory disease and non-relapse/refractory-related mortality (NRRrM), treatment-related toxicities, patient comorbidities and chemotherapy dosing strategies were analyzed as secondary endpoints. Obese patients (body mass index, BMI ≥ 30) displayed a significant inferior median OS (29.44 vs. 47.94 months, p = 0.015) without a significant difference in median EFS (7.8 vs. 9.89 months, p = 0.3) compared to non-obese patients (BMI < 30). The cumulative incidence (CI) of NRRrM was significantly increased in obese patients compared to non-obese patients while no differences could be observed regarding the CI of relapsed or refractory disease. Obesity was identified as an independent risk factor for death (HR 1.27, [95% CI 1.07-1.51], p = 0.005) in a multivariable Cox regression analysis. When the cohort was stratified by age (≥/< 60 years), the difference in OS as well as the significantly increased CI of NRRrM was only observed in patients ≥ 60 years. Notably, obese patients demonstrated higher rates of cardiovascular and metabolic comorbidities regardless of their age. No disparities for OS, EFS, CR1 rate or treatment-related toxicities were observed when the entire study population was stratified for the used dosing strategy (dose calculation using total body weight, idealized body weight, adjusted idealized body weight or capped at body surface area of 2 m 2). In conclusion, the present study identifies obesity as a major independent risk factor for worse overall survival and increased CI of non-relapse/refractory-related mortality in older (≥60 years) AML patients undergoing curative IT. These findings may be most likely attributed to obesity related comorbidities and not to dose adaption of chemotherapy in obese AML patients. Disclosures Schliemann: Boehringer-Ingelheim: Research Funding; Abbvie: Consultancy, Other: travel grants; Philogen S.p.A.: Consultancy, Honoraria, Research Funding; Astellas: Consultancy; AstraZeneca: Consultancy; BMS: Consultancy, Other: travel grants; Jazz Pharmaceuticals: Consultancy, Research Funding; Novartis: Consultancy; Roche: Consultancy; Pfizer: Consultancy. Krause: Siemens: Research Funding; Takeda: Honoraria; Pfizer: Honoraria; art-tempi: Honoraria; Kosmas: Honoraria; Gilead: Other: travel support; Abbvie: Other: travel support. Haenel: Jazz: Consultancy, Honoraria; GSK: Consultancy; Bayer Vital: Honoraria; Takeda: Consultancy, Honoraria; Roche: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Amgen: Consultancy; Celgene: Consultancy, Honoraria. Fransecky: Amgen: Honoraria; Abbvie: Honoraria, Research Funding; Novartis: Honoraria; Medac: Honoraria; Takeda: Honoraria. Burchert: Novartis: Honoraria, Research Funding; AOP Orphan: Honoraria, Research Funding; Pfizer: Honoraria; Incyte: Honoraria; Gilead: Honoraria; BMS: Honoraria. Crysandt: Incyte: Honoraria; Pfizer: Membership on an entity's Board of Directors or advisory committees. Müller-Tidow: Janssen: Consultancy, Research Funding; Bioline: Research Funding; Pfizer: Research Funding. Platzbecker: Celgene/BMS: Honoraria; AbbVie: Honoraria; Janssen: Honoraria; Novartis: Honoraria; Takeda: Honoraria; Geron: Honoraria. Baldus: Jazz: Honoraria; Novartis: Honoraria; Amgen: Honoraria; Celgene/BMS: Honoraria.
Authors 33
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University Hospital Frankfurt · Goethe University Frankfurt
Affiliation as printed
Department of Medicine II, Hematology and Oncology, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
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University Hospital Frankfurt · Goethe University Frankfurt
Affiliation as printed
Department of Medicine II, Hematology and Oncology, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
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University Hospital Frankfurt · Goethe University Frankfurt
Affiliation as printed
Department of Medicine II, Hematology and Oncology, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
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University Hospital Frankfurt · Goethe University Frankfurt
Affiliation as printed
Department of Medicine II, Hematology and Oncology, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
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University Hospital Carl Gustav Carus
Affiliation as printed
Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
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University Hospital Carl Gustav Carus
Affiliation as printed
Department of Internal Medicine I, University Hospital Carl-Gustav-Carus Dresden, Dresden, Germany
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Affiliation as printed
Department of Medicine A, University Hospital Münster, Münster, Germany
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Affiliation as printed
Department of Medicine A, University Hospital Münster, Münster, Germany
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Affiliation as printed
Department of Hematology and Medical Oncology, University Hospital Erlangen, Erlangen, Germany
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University Hospital Heidelberg
Affiliation as printed
Department of Medicine V, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
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Affiliation as printed
Department of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany
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Affiliation as printed
Department of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany
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University of Würzburg · Universitätsklinikum Würzburg
Affiliation as printed
Department of Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
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Affiliation as printed
Department of Hematology, Oncology and Palliative Medicine, Robert-Bosch-Hospital, Stuttgart, Germany
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Affiliation as printed
Department of Internal Medicine III, Chemnitz Hospital, Chemnitz, Germany
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University Hospital Schleswig-Holstein
Affiliation as printed
Department of Internal Medicine II, University Hospital Schleswig-Holstein, Kiel, Germany
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Universitätsklinikum Gießen und Marburg
Affiliation as printed
Department of Hematology, Oncology and Immunology, University Hospital Marburg, Marburg, Germany
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Universitätsklinikum Gießen und Marburg
Affiliation as printed
Department of Hematology, Oncology and Immunology, University Hospital Marburg, Marburg, Germany
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RWTH Aachen University · Universitätsklinikum Aachen
Affiliation as printed
Department of Internal Medicine IV, University Hospital RWTH Aachen, Aachen, Germany
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RWTH Aachen University · Universitätsklinikum Aachen
Affiliation as printed
Department of Internal Medicine IV, University Hospital RWTH Aachen, Aachen, Germany
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Affiliation as printed
Department of Hematology/Oncology and Palliative Medicine, Ev. Stift St. Martin, Koblenz, Germany
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Affiliation as printed
Department of Internal Medicine 5, Hospital Nürnberg, Nürnberg, Germany
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Affiliation as printed
Department of Internal Medicine I, Westpfalz-Klinikum, Kaiserslautern, Germany
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Affiliation as printed
Department of Hematology and Oncology, St. Bernward Krankenhaus, Hildesheim, Germany
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Affiliation as printed
Hematology and Oncology, University Hospital of Halle (Saale), Halle (Saale), Germany
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Affiliation as printed
Department of Hematology, Oncology and Palliative Medicine, Rems-Murr-Klinikum Winnenden, Winnenden, Germany
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University Hospital Heidelberg
Affiliation as printed
Department of Medicine V, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
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Affiliation as printed
University Hospital Leipzig, Leipzig, Germany
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University Hospital Schleswig-Holstein
Affiliation as printed
Department of Internal Medicine II, University Hospital Schleswig-Holstein, Kiel, Germany
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University Hospital Carl Gustav Carus
Affiliation as printed
Department of Internal Medicine I, University Hospital Dresden, Dresden, Germany
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University Hospital Carl Gustav Carus
Affiliation as printed
Department of Internal Medicine I, University Hospital Dresden, Dresden, Germany
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University Hospital Frankfurt · Goethe University Frankfurt
Affiliation as printed
Department of Medicine II, Hematology and Oncology, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
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University Hospital Frankfurt · Goethe University Frankfurt
Affiliation as printed
Department of Medicine II, Hematology/Oncology, Goethe University, University Hospital, Frankfurt, Germany
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