Lipid profile as a novel prognostic predictor for patients with acute myeloid leukemia

Abstract

PurposeThis study investigated the relationship between serum lipid levels and clinical outcomes in acute myeloid leukemia (AML) by establishing a predictive risk classification model.MethodA total of 214 AML patients who were pathologically diagnosed and treated with standard induction chemotherapy at Sun Yat-Sen University Cancer Center were included. The patients were randomly divided into the training (n = 107) and validation (n=107) cohorts. Univariate and multivariate Cox analyses were used to assess the value of triglyceride (TG), Apolipoprotein B (Apo B), Apo Apolipoprotein A-I (Apo A-I), cholesterol (CHO), and high-density lipoprotein (HDL) as prognostic factors for AML.ResultsAfter a series of data analyses, a five-factor model was established to divide the patients into high- and low-risk groups. Kaplan-Meier survival analysis showed that the high-risk group had a poor prognosis (P<0.05). The area under the curve of the novel model for five-year OS was 0.737. A nomogram was constructed to integrate the model with age and the 2017 ELN cytogenetic classification, with the merged model showing improved accuracy with an area under the curve of 0.987 for five-year OS.ConclusionA novel model was constructed using a combination of the serum lipid profile and clinical characteristics of AML patients to enhance the predictive accuracy of clinical outcomes. The nomogram used the lipid profile which is routinely tested in clinical blood biochemistry and showed both specific prognostic and therapeutic potential.

Upregulated cholesterol biosynthesis facilitates the survival of methylation-retaining AML cells following decitabine treatment

“…Increased cholesterol demand is an established feature of AML cells 56 , and upregulation of cholesterol biosynthesis genes has shown prognostic value in AML [57][58][59] . While the precise mechanisms by which cholesterol confers a survival advantage remain unclear, inhibiting cholesterol biosynthesis has been shown to sensitize AML cells to radiation and chemotherapy 60,61 .…”

Metabolic instruction of the graft-versus-leukemia immunity

“…Lipid profiling of plasma samples from AML patients revealed an incresed concentration of phosphatidyl-inositol and free fatty acids in the plasma of patients with an unfavorable prognosis (n=5) compared to patients with a favorable prognosis (n=5) ( 81 ). Another study analyzing the serum lipid levels in 214 AML patient samples found, among others, apolipoprotein B and high-density lipoprotein cholesterol to be prognostic factors for the clinical outcome ( 82 ). Furthermore, AML blasts can induce the phosphorylation of hormone-sensitive lipase in bone marrow adipocytes and activate lipolysis, leading to the release of fatty acids from adipocytes ( 83 ).…”

Obesity and Leukemia: Biological Mechanisms, Perspectives, and Challenges

“…Elevated circulating triglyceride and lower HDL-cholesterol levels have been consistently observed in ALL and AML [ 158 – 162 ]. Accordingly, overall survival in AML patients has been shown to be independently associated with elevated triglyceride and reduced HDL levels before treatment initiation [ 163 ]. Of note, this pattern is consistent with the so-called diabetic dyslipidemia, which likely emerges as a result of insulin resistance and increased production of large buoyant VLDL1 particles by the liver [ 164 , 165 ].…”