Increased BMI correlates with higher risk of disease relapse and differentiation syndrome in patients with acute promyelocytic leukemia treated with the AIDA protocols
Increased BMI correlates with higher risk of disease relapse and differentiation syndrome in patients with acute promyelocytic leukemia treated with the AIDA protocols
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DOI：
10.1182/blood-2011-07-369595
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发表时间：
2012-01-05
期刊：
影响因子：
20.3
通讯作者：
Lo-Coco, Francesco
中科院分区：
文献类型：
--
作者：
Breccia, Massimo;Mazzarella, Luca;Lo-Coco, Francesco
我们研究了体重指数（BMI）是否与新诊断的急性早幼粒细胞白血病（APL）的不同结局相关。研究人群包括144例新诊断和遗传学确诊的APL患者，这些患者在一家机构连续接受治疗。根据GIMEMA方案AIDA-0493和AIDA-2000，所有患者均接受全反式维甲酸和艾达鲁肽治疗。根据BMI进行结局估计，并对复发和分化综合征的风险进行多变量分析。54例（37.5%）患者体重不足/正常（BMI < 25），而90例（62.5%）患者超重/肥胖（BMI >= 25）。BMI增加与年龄（P <0.0001）和男性（P <0.02）相关。在多变量分析中，BMI是分化综合征最有力的预测因子（比值比= 7.24; 95%CI，1.50-34; P = 0.014）。中位随访6年后，超重/肥胖患者5年时复发的估计累积发生率为31.6%（95% CI，22.7%-43.8%），体重不足/正常体重患者为11.2%（95% CI，5.3%-23.8%）（P = 0.029）。多变量分析显示，BMI是复发的独立预测因子（超重/肥胖vs体重不足/正常患者的风险比= 2.45，95%CI，1.00-5.99，P = 0.049）。在AIDA方案治疗的APL患者中，诊断时BMI增加与发生分化综合征和疾病复发的风险增加相关。（血。2012; 119（1）：49-54）
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. (Blood. 2012; 119(1): 49-54)