Characteristics and outcome of adult patients with acute promyelocytic leukemia and increased body mass index treated with the PETHEMA Protocols

Sobas, Marta; Rodríguez‐Veiga, Rebeca; Vellenga, Edo; Paluszewska, Monika; Serna, Javier de la; García-Álvarez, Flor; Gil, Cristina; Brunet, Salut; Bergua, Juan; González‐Campos, José; Ribera, Josep‐Marǐa; Tormo, Mar; González, Marcos; Fernández, Isolda; Benavente, Celina; González-Sanmiguel, José David; Esteve, Jordi; Pérez‐Encinas, Manuel; Salamero, Olga; Manso, Félix; Löwenberg, Bob; Sanz, Miguel Á.; Montesinos, Pau

doi:10.1111/ejh.13346

Cited by 6 publications

(4 citation statements)

References 23 publications

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“…Many risk factors such as increased body mass index (BMI), diet, cigarette smoking, low physical activity could be responsible for the development of s-NPLs in the general population. Interestingly, the majority (59%) of APL patients are overweight or obese (BMI ≥25) [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence, risk factors, and outcomes of second neoplasms in patients with acute promyelocytic leukemia: the PETHEMA-PALG experience

Sobas,

Knopinska-Posluszny,

Piątkowska-Jakubas

et al. 2023

Ann Hematol

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The most important challenges in acute promyelocytic leukemia (APL) is preventing early death and reducing long-term events, such as second neoplasms (s-NPLs). We performed a retrospective analysis of 2670 unselected APL patients, treated with PETHEMA “chemotherapy based” and “chemotherapy free” protocols. Only de novo APL patients who achieved complete remission (CR) and completed the three consolidation cycles were enrolled into the analysis. Out of 2670 APL patients, there were 118 (4.4%) who developed s-NPLs with the median latency period (between first CR and diagnosis of s-NPL) of 48.0 months (range 2.8–231.1): 43.3 (range: 2.8–113.9) for s-MDS/AML and 61.7 (range: 7.1–231.1) for solid tumour. The 5-year CI of all s-NPLs was of 4.43% and 10 years of 7.92%. Among s-NPLs, there were 58 cases of s-MDS/AML, 3 cases of other hematological neoplasms, 57 solid tumours and 1 non-identified neoplasm. The most frequent solid tumour was colorectal, lung and breast cancer. Overall, the 2-year OS from diagnosis of s-NPLs was 40.6%, with a median OS of 11.1 months. Multivariate analysis identified age of 35 years (hazard ratio = 0.2584; p < 0.0001) as an independent prognostic factor for s-NPLs. There were no significant differences in CI of s-NPLs at 5 years between chemotherapy-based vs chemotherapy-free regimens (hazard ratio = 1.09; p = 0.932). Larger series with longer follow-up are required to confirm the potential impact of ATO+ATRA regimens to reduce the incidence of s-NPLs after front-line therapy for APL.

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Section: Discussionmentioning

confidence: 99%

Incidence, risk factors, and outcomes of second neoplasms in patients with acute promyelocytic leukemia: the PETHEMA-PALG experience

Sobas,

Knopinska-Posluszny,

Piątkowska-Jakubas

et al. 2023

Ann Hematol

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“… 43 Patients who were underweight, overweight, and obese had poorer survival than those with normal BMI, which is in agreement with other studies that have shown a trend toward poor overall survival in overweight/obese patients with leukemia. 44 , 45 Comorbid management and supportive therapies for very ill patients remain an important consideration in our setting.…”

Section: Discussionmentioning

confidence: 99%

One-Year Survival and Prognosticators of Adults With Acute Leukemia at the Uganda Cancer Institute

Natukunda

Omoding

Bongomin

et al. 2023

JCO Global Oncology

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PURPOSE Acute leukemias are associated with substantial morbidity and mortality, particularly in the adult population. Despite an increasing burden of acute leukemia in developing countries, there are limited data on clinical outcomes and prognostic factors in this setting. In this study, we aimed to describe the clinical characteristics, survival, and prognostic factors of adults with acute leukemia at the Uganda Cancer Institute (UCI). METHODS A retrospective cohort study was conducted between January 2009 and December 2018, reviewing data of patients 18 years or older with a cytopathologic diagnosis of acute leukemia at UCI. Data were extracted on clinical and laboratory characteristics, response to treatment, and survival. Cox-proportional hazards regression and survival analysis were performed to determine survival rates and associated factors. P < .05 was considered statistically significant. RESULTS In total, 233 participants were enrolled. Most (59.2%. n = 138) participants were male, with a median age of 32 years (IQR, 23-48 years), and 136 (58.4%) had AML. Overall, the 1-year survival was 16.5%, with a median survival time of 47 (IQR, 21-219) days. Predictors of mortality were being a female (adjusted hazard ratio [aHR], 2.8; 95% CI, 1.2 to 6.7; P = .022) and overweight (aHR, 4.2; 95% CI, 1.3 to 13.4; P = .015). Among the patients who had AML, the predictors were poor Eastern Cooperative Oncology Group (ECOG; aHR, 3.1; 95% CI, 1.6 to 6.2; P = .001) and HIV (aHR, 6.0; 95% CI, 1.7 to 20.5; P = .004). Among the patients who had ALL, the predictors were poor ECOG (aHR, 2.3; 95% CI, 1.3 to 4.1; P = .006). CONCLUSION Patients with acute leukemia in Uganda have poor overall survival. Prospective studies are recommended to better understand causes of early mortality.

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“…This has been attributed, at least in part, to dose capping of chemotherapy to a maximum body surface area of 2 m 2 and consequent under‐treatment, suggesting a potentially important therapy dosing effect 23 . Importantly, in acute promyelocytic leukemia, in which obesity is more prevalent, 24,25 higher complication and relapse rates have also been observed with obesity, 26–28 as confirmed in a retrospective Cancer and Leukemia Group B analysis 29 …”

Section: Introductionmentioning

confidence: 87%

Obesity in adult acute myeloid leukemia is not associated with inferior response or survival even when dose capping anthracyclines: An ECOG‐ACRIN analysis

Foran

Sun

Lai

et al. 2023

Cancer

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Background Obesity (body mass index [BMI] ≥30 kg/m2) is an important epidemiological risk factor for developing acute myeloid leukemia (AML). Therefore, the authors studied the association of obesity with clinical and genetic phenotype and its impact on outcome in adults with AML. Methods The authors analyzed BMI in 1088 adults who were receiving intensive remission induction and consolidation therapy in two prospective, randomized therapeutic clinical trials of the Eastern Cooperative Oncology Group‐American College of Radiology Imaging Network: E1900 (ClinicalTrials.gov identifier NCT00049517; patients younger than 60 years) and E3999 (ClinicalTrials.gov identifier NCT00046930; patients aged 60 years or older). Results Obesity was prevalent at diagnosis (33%) and, compared with nonobesity, was associated with intermediate‐risk cytogenetics group (p = .008), poorer performance status (p = .01), and a trend toward older age (p = .06). Obesity was not associated with somatic mutations among a selected 18‐gene panel that was tested in a subset of younger patients. Obesity was not associated with clinical outcome (including complete remission, early death, or overall survival), and the authors did not identify any patient subgroup that had inferior outcomes based on BMI. Obese patients were significantly more likely to receive <90% of the intended daunorubicin dose despite protocol specification, particularly in the E1900 high‐dose (90 mg/m2) daunorubicin arm (p = .002); however, this did not correlate with inferior overall survival on multivariate analysis (hazard ratio, 1.39; 95% confidence interval, 0.90–2.13; p = .14). Conclusions Obesity is associated with unique clinical and disease‐related phenotypic features in AML and may influence physician treatment decisions regarding daunorubicin dosing. However, the current study demonstrates that obesity is not a factor in survival, and strict adherence to body surface area‐based dosing is not necessary because dose adjustments do not affect outcomes.

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Characteristics and outcome of adult patients with acute promyelocytic leukemia and increased body mass index treated with the PETHEMA Protocols

Cited by 6 publications

References 23 publications

Incidence, risk factors, and outcomes of second neoplasms in patients with acute promyelocytic leukemia: the PETHEMA-PALG experience

Incidence, risk factors, and outcomes of second neoplasms in patients with acute promyelocytic leukemia: the PETHEMA-PALG experience

One-Year Survival and Prognosticators of Adults With Acute Leukemia at the Uganda Cancer Institute

Obesity in adult acute myeloid leukemia is not associated with inferior response or survival even when dose capping anthracyclines: An ECOG‐ACRIN analysis

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