title: Comorbidity, age, and mortality among adults treated intensively for acute myeloid leukemia (AML).
abstract: BACKGROUND
  Our goal was to characterize comorbidities among adults receiving intensive therapy for AML, and investigate their association with outcomes.
  
  
  METHODS
  We retrospectively analyzed 277 consecutive patients with newly diagnosed AML treated intensively at the Comprehensive Cancer Center of Wake Forest University from 2002 to 2009. Pretreatment comorbidities were identified by ICD-9 codes and chart review. Comorbidity burden (modified Charlson Comorbidity Index [CCI]) and specific conditions were analyzed individually. Outcomes were overall survival (OS), remission, and 30-day mortality. Covariates included age, gender, cytogenetic characteristics, hemoglobin, white cell count, lactate dehydrogenase, body mass index, and insurance type. Cox proportional hazards models were used to evaluate OS; logistic regression was used for remission and 30-day mortality.
  
  
  RESULTS
  In this series, 144 patients were ≥ 60 years old (median age 70 years, median survival 8.7 months) and 133 were <60 years (median age 47 years, median survival 23.1 months). Older patients had a higher comorbidity burden (CCI≥1 58% versus 26%, P<0.001). Prevalent comorbid conditions differed by age (diabetes 19.2% versus 7.5%; cardiovascular disease 12.5% versus 4.5%, for older versus younger patients, respectively). The CCI was not independently associated with OS or 30-day mortality in either age group. Among older patients, diabetes was associated with higher 30-day mortality (33.3% vs. 12.0% in diabetic vs. non-diabetic patients, p=0.006). Controlling for age, cytogenetic characteristics and other comorbidities, the presence of diabetes increased the odds of 30-day mortality by 4.9 (CI 1.6-15.2) times.
  
  
  CONCLUSIONS
  Diabetes is adversely associated with 30-day survival in older AML patients receiving intensive therapy.
authors.affiliation: Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA.
authors.forename: Bernard
authors.initials: B
authors.lastname: Tawfik
authors.affiliation: Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Pardee
authors.affiliation: Division of Public Health Sciences, Department of Biostatistics, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Isom
authors.affiliation: Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA.
authors.forename: Sarunas
authors.initials: S
authors.lastname: Sliesoraitis
authors.affiliation: Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Winter
authors.affiliation: Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Lawrence
authors.affiliation: Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA.
authors.forename: Bayard L
authors.initials: BL
authors.lastname: Powell
authors.affiliation: Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA. Electronic address: hklepin@wakehealth.edu.
authors.forename: Heidi D
authors.initials: HD
authors.lastname: Klepin
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D015470:Leukemia, Myeloid, Acute / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Acute myeloid leukemia; Aged; Comorbidity; Diabetes; Remission induction; Survival