title: Relationship between obesity and clinical outcome in adults with acute myeloid leukemia: A pooled analysis from four CALGB (alliance) clinical trials.
abstract: Obesity has been previously suggested as an adverse prognostic marker in patients with acute leukemia. To evaluate the relationship between obesity and clinical outcome, disease-free survival (DFS) and overall survival (OS), in patients with acute myelogenous leukemia (AML), including acute promyelocytic leukemia (APL), we performed a pooled analysis of four CALGB (Alliance) clinical trials. Our study included 446 patients with APL from CALGB 9710, and 1,648 patients between 18 and 60 years of age with non-APL AML from CALGB 9621, 10503, and 19808. Obesity was defined as BMI ≥30 kg/m(2). Multivariate Cox proportional-hazard regression models were fitted for DFS and OS. Obesity was seen in 50% and 38% of APL and non-APL AML patients, respectively. In APL patients, obesity was associated with worse DFS (HR 1.53, 95% CI 1.03-2.27; P = 0.04) and OS (HR 1.72, 95% CI 1.15-2.58; P = 0.01) after adjusting for age, sex, performance status, race, ethnicity, treatment arm and baseline white blood cell count. Obesity was not significantly associated with DFS or OS in the non-APL AML patients. In conclusion, our study indicates that obesity has significant prognostic value for DFS and OS in APL patients, but not for non-APL AML patients.
authors.affiliation: Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jorge J
authors.initials: JJ
authors.lastname: Castillo
authors.affiliation: Alliance Statistics and Data Center, Duke University, Durham, North Carolina.
authors.forename: Flora
authors.initials: F
authors.lastname: Mulkey
authors.affiliation: Health Informatics Institute, University of South Florida, Tampa, Florida.
authors.forename: Susan
authors.initials: S
authors.lastname: Geyer
authors.affiliation: Monter Cancer Center, Lake Success, New York.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Kolitz
authors.affiliation: Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
authors.forename: William
authors.initials: W
authors.lastname: Blum
authors.affiliation: Section on Hematology and Oncology, Comprehensive Cancer Center of Wake Forest University, Winston-Salem, North Carolina.
authors.forename: Bayard L
authors.initials: BL
authors.lastname: Powell
authors.affiliation: Alliance Statistics and Data Center, Duke University, Durham, North Carolina.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: George
authors.affiliation: Section of Hematology and Oncology, Comprehensive Cancer Center, University of Chicago, Chicago, Illinois.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Larson
authors.affiliation: Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Stone
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D015992:Body Mass Index; D001830:Body Surface Area; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D016896:Treatment Outcome