title: Increased BMI correlates with higher risk of disease relapse and differentiation syndrome in patients with acute promyelocytic leukemia treated with the AIDA protocols.
abstract: We investigated whether body mass index (BMI) correlates with distinct outcomes in newly diagnosed acute promyelocytic leukemia (APL). The study population included 144 patients with newly diagnosed and genetically confirmed APL consecutively treated at a single institution. All patients received All-trans retinoic acid and idarubicin according to the GIMEMA protocols AIDA-0493 and AIDA-2000. Outcome estimates according to the BMI were carried out together with multivariable analysis for the risk of relapse and differentiation syndrome. Fifty-four (37.5%) were under/normal weight (BMI < 25), whereas 90 (62.5%) patients were overweight/obese (BMI ≥ 25). An increased BMI was associated with older age (P < .0001) and male sex (P = .02). BMI was the most powerful predictor of differentiation syndrome in multivariable analysis (odds ratio = 7.24; 95% CI, 1.50-34; P = .014). After a median follow-up of 6 years, the estimated cumulative incidence of relapse at 5 years was 31.6% (95% CI, 22.7%-43.8%) in overweight/obese and 11.2% (95% CI, 5.3%-23.8%) in underweight/normal weight patients (P = .029). Multivariable analysis showed that BMI was an independent predictor of relapse (hazard ratio = 2.45, 95% CI, 1.00-5.99, in overweight/obese vs under/normal weight patients, P = .049). An increased BMI at diagnosis is associated with a higher risk of developing differentiation syndrome and disease relapse in APL patients treated with AIDA protocols.
authors: Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy. breccia@bce.uniroma1.it
authors: Massimo
authors: M
authors: Breccia
authors: Luca
authors: L
authors: Mazzarella
authors: Vincenzo
authors: V
authors: Bagnardi
authors: Davide
authors: D
authors: Disalvatore
authors: Giuseppina
authors: G
authors: Loglisci
authors: Giuseppe
authors: G
authors: Cimino
authors: Anna Maria
authors: AM
authors: Testi
authors: Giuseppe
authors: G
authors: Avvisati
authors: Maria Concetta
authors: MC
authors: Petti
authors: Clara
authors: C
authors: Minotti
authors: Roberto
authors: R
authors: Latagliata
authors: Robin
authors: R
authors: Foà
authors: Pier Giuseppe
authors: PG
authors: Pelicci
authors: Francesco
authors: F
authors: Lo-Coco
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015255:Idarubicin / Q000009:adverse effects; D007223:Infant; D007231:Infant, Newborn; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000209:etiology*; D009765:Obesity / Q000150:complications*; D050177:Overweight / Q000150:complications*; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D013577:Syndrome; D014212:Tretinoin / Q000009:adverse effects / Q000378:metabolism*; D055815:Young Adult
chemical_list: D014212:Tretinoin; D015255:Idarubicin