title: Smokers with chronic myeloid leukemia are at a higher risk of disease progression and premature death.
abstract: BACKGROUND
  Smoking is suspected to not only be a risk factor for chronic myeloid leukemia but an adverse prognostic factor for the disease as well. The objective of the current study was to investigate the impact of smoking on survival and progression to advanced phases of disease.
  
  
  METHODS
  Based on the data of the German CML Study IV, the authors analyzed the effect of smoking using a multivariate Cox model with the addition of the European Treatment and Outcome Study (EUTOS) long-term survival score variables of age, spleen size, thrombocytes, and peripheral blasts as well as sex, comorbidities, and type of treatment center.
  
  
  RESULTS
  The 8-year survival probability was 87% for a nonsmoking patient and 83% for a patient who smoked. The authors noted a 2.08-times higher risk of death for smokers in comparison with nonsmokers and a 2.11-times higher cause-specific hazard of disease progression. An interaction between smoking and age was found in the model for survival. No significant difference with regard to molecular response was observed.
  
  
  CONCLUSIONS
  Even when considering differences in socioeconomic status and lifestyle between patients who smoke and nonsmokers, the current analysis demonstrated that smoking also might affect disease biology. The results of the current study indicate that patients with chronic myeloid leukemia, in particular those aged <60 years, should be encouraged to quit smoking. Cancer 2017;123:2467-71. © 2017 American Cancer Society.
authors.affiliation: Institute for Medical Information Sciences, Biometry, and Epidemiology (IBE), Ludwig-Maximilians University, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Lauseker
authors.affiliation: Institute for Medical Information Sciences, Biometry, and Epidemiology (IBE), Ludwig-Maximilians University, Munich, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Hasford
authors.affiliation: Department of Medicine, University of Heidelberg, Mannheim, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Saussele
authors.affiliation: Department of Hematology/Oncology, Caritas-Krankenhaus Lebach, Lebach, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Kremers
authors.affiliation: Department of Oncology and Hematology, Oldenburg Clinic, Oldenburg, Germany.
authors.forename: Doris
authors.initials: D
authors.lastname: Kraemer
authors.affiliation: Hematology/Oncology Clinic, St. Marien Hospital, Katholisches Krankenhaus Hagen, Hagen, Germany.
authors.forename: Walter
authors.initials: W
authors.lastname: Lindemann
authors.affiliation: Department of Medicine, University of Heidelberg, Mannheim, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Hehlmann
authors.affiliation: Institute for Medical Information Sciences, Biometry, and Epidemiology (IBE), Ludwig-Maximilians University, Munich, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Pfirrmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012907:Smoking / Q000453:epidemiology*; D055815:Young Adult
keywords: chronic myeloid leukemia (CML); mortality; prognosis; progression; smoking