title: Impact of body-surface area on patients' outcome in younger adults with acute myeloid leukemia.
abstract: OBJECTIVE
  Anthracyclines and cytarabine are cornerstones for intensive chemotherapy in acute myeloid leukemia (AML). The goals of this study were to comprehensively assess deviations from theoretical doses and the impact of body-surface area (BSA) on patients' characteristics, physicians' strategy, dose adjustment, and clinical outcome.
  
  
  METHODS
  The GOELAMS 2001 phase III trial included 823 AML patients below 60 years of age. In the course of treatment, anthropomorphic parameters and chemotherapy doses were prospectively registered.
  
  
  RESULTS
  Very high BSA (≥2.15 m2) was the factor most significantly associated with the physician's decision to reduce chemotherapy doses during induction and postremission therapy. Despite similar AML characteristics and therapeutic strategies, the very high BSA group exhibited a significantly worse survival (5-years OS of 27%) compared to the low (BSA≤1.5 m2), intermediate (1.5 m2<BSA≤2.0 m2), or high (2 m2<BSA<2.15 m2) BSA groups (46%, 47%, 56%, respectively) (P=.009). In the very high BSA group, dose capping was associated with worse overall survival, although not significantly (P=.09).
  
  
  CONCLUSIONS
  The presence of a very high BSA is the main reason prompting physicians to reduce chemotherapy doses in adult AML. Furthermore, these patients display a poor outcome and could benefit from full doses calculated on actual BSA.
authors.affiliation: Department of Hematology, Hôpital Pontchaillou, CHU, Rennes, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Cahu
authors.affiliation: Department of Hematology, CHU Grenoble Alpes, La Tronche, France.
authors.forename: Martin
authors.identifier: http://orcid.org/0000-0001-5834-7654
authors.initials: M
authors.lastname: Carré
authors.affiliation: Department of Hematology, CHU de Toulouse, Centre de Recherches en Cancerologie de Toulouse, Universite Paul Sabatier, Toulouse, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Recher
authors.affiliation: Department of Hematology, CHU Bordeaux, Université Bordeaux, Bordeaux, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Pigneux
authors.affiliation: Department of Hematology, CHU Angers, Angers, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Hunault-Berger
authors.affiliation: Department of Hematology, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Norbert
authors.initials: N
authors.lastname: Vey
authors.affiliation: Department of Hematology, CHU Nantes, Nantes, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Chevallier
authors.affiliation: Department of Hematology, Centre Catherine de Sienne, Nantes, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Delaunay
authors.affiliation: Department of Hematology and Cell Therapy, UMR CNRS 7292, Centre Hospitalier Universitaire, Tours, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Gyan
authors.affiliation: Department of Hematology, Hopitaux Universitaires de Strasbourg, Strasbourg, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Lioure
authors.affiliation: Department of Hematology, CHU Vandoeuvre-les-Nancy, Nancy, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Bonmati
authors.affiliation: Department of Hematology, CHU Reims, Reims, France.
authors.forename: Chantal
authors.initials: C
authors.lastname: Himberlin
authors.affiliation: Department of Hematology, CHU Montpellier, Montpellier, France.
authors.forename: Yosr
authors.initials: Y
authors.lastname: Hicheri
authors.affiliation: Department of Hematology, CHU Brest, Brest, France.
authors.forename: Gaelle
authors.initials: G
authors.lastname: Guillerm
authors.affiliation: Department of Hematology, Hôpital Cochin, AP-HP, Paris, France.
authors.forename: Bouscary
authors.initials: B
authors.lastname: Didier
authors.affiliation: Department of Hematology, CHU Besançon, Besançon, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Larosa
authors.affiliation: Department of Hematology, Centre Hospitalier Mulhouse, Mulhouse, France.
authors.forename: Mario
authors.initials: M
authors.lastname: Ojeda-Uribe
authors.affiliation: Department of Hematology, Hôpital Pontchaillou, CHU, Rennes, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Bernard
authors.affiliation: Hematology Laboratory, CHU Nantes, Nantes, France.
authors.forename: Marie C
authors.initials: MC
authors.lastname: Bene
authors.affiliation: Department of Hematology, CHU Angers, Angers, France.
authors.forename: Norbert
authors.initials: N
authors.lastname: Ifrah
authors.affiliation: Department of Hematology, CHU Grenoble Alpes, La Tronche, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Cahn
mesh_terms: D000328:Adult; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001830:Body Surface Area; D001837:Body Weights and Measures; D017326:Clinical Trials, Phase III as Topic; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D015337:Multicenter Studies as Topic; D012008:Recurrence; D012074:Remission Induction; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: acute myeloid leukemia; body-surface area; dose intensity; dose reduction