Laura Finn1, Lisa Sproat2, Michael G Heckman3, Liuyan Jiang4, Nancy N Diehl5, Rhett Ketterling6, Raoul Tibes7, Ricardo Valdez8, James Foran9. 1. Division of Hematology and Medical Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, United States. Electronic address: finn.laura@mayo.edu. 2. Division of Hematology and Medical Oncology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, United States. Electronic address: Sproat.Lisa@mayo.edu. 3. Division of Biomedical Statistics and Informatics, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, United States. Electronic address: Heckman.Michael@mayo.edu. 4. Division of Laboratory Medicine/Pathology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, United States. Electronic address: Jiang.Liuyan@mayo.edu. 5. Division of Biomedical Statistics and Informatics, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, United States. Electronic address: Diehl.Nancy@mayo.edu. 6. Division of Laboratory Medicine/Pathology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States. Electronic address: Ketterling.Rhett@mayo.edu. 7. Division of Hematology and Medical Oncology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, United States. Electronic address: Tibes.Raoul@mayo.edu. 8. Division of Laboratory Medicine/Pathology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, United States. Electronic address: rvaldez@miracals.com. 9. Division of Hematology and Medical Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, United States. Electronic address: Foran.James@mayo.edu.
Abstract
BACKGROUND: An increased risk of adult myeloid leukemia (AML) has recently been associated with lifestyle and environmental exposures, including obesity, smoking, some over the counter medications, and rural/farm habitats in case control studies. The association of these exposures with AML cytogenetic categories, outcomes after therapy, and overall survival is unknown. METHODS: Relevant exposures were evaluated in a cohort of 295 consecutive AML patients diagnosed and treated at Mayo Clinic in Florida and Arizona. Standard cytogenetic risk categories were applied and reviewed in a central cytogenetic laboratory. The association of epidemiologic exposures with cytogenetic risk, complete remission after therapy, and overall survival was evaluated using logistic and Cox regression models. RESULTS: A significant association between obesity and intermediate-abnormal cytogenetics was identified (OR: 1.94, P=0.025). Similarly, those with secondary AML were more likely to have poor risk (OR: 2.55, P<0.001) and less likely to have intermediate normal (OR: 0.48, P=0.003) cytogenetics. In multivariate analysis, overall survival was improved for patients ≥ 60 years receiving intensive (RR: 0.21, P<0.001) and non-intensive therapy (RR: 0.40, P<0.001 compared to no treatment, and was lower for users of tobacco (RR 1.39, P=0.032), and those with poor risk cytogenetics (RR: 3.96, P=0.002) or poor performance status (RR: 1.69, P<0.001). Furthermore, an association between statin use at the time of diagnosis (OR: 2.89, P=0.016) and increased complete remission after intensive chemotherapy was identified, while prior solid organ transplantation was associated with significantly lower complete remission rate after therapy (OR: 0.10, P=0.035). CONCLUSION: Our results provide evidence that specific epidemiologic exposures, including obesity, are significantly associated with unique AML cytogenetic risk categories and response to therapy. This supports a link between patient lifestyles, clinical exposures, and leukemogenesis.
BACKGROUND: An increased risk of adult myeloid leukemia (AML) has recently been associated with lifestyle and environmental exposures, including obesity, smoking, some over the counter medications, and rural/farm habitats in case control studies. The association of these exposures with AML cytogenetic categories, outcomes after therapy, and overall survival is unknown. METHODS: Relevant exposures were evaluated in a cohort of 295 consecutive AMLpatients diagnosed and treated at Mayo Clinic in Florida and Arizona. Standard cytogenetic risk categories were applied and reviewed in a central cytogenetic laboratory. The association of epidemiologic exposures with cytogenetic risk, complete remission after therapy, and overall survival was evaluated using logistic and Cox regression models. RESULTS: A significant association between obesity and intermediate-abnormal cytogenetics was identified (OR: 1.94, P=0.025). Similarly, those with secondary AML were more likely to have poor risk (OR: 2.55, P<0.001) and less likely to have intermediate normal (OR: 0.48, P=0.003) cytogenetics. In multivariate analysis, overall survival was improved for patients ≥ 60 years receiving intensive (RR: 0.21, P<0.001) and non-intensive therapy (RR: 0.40, P<0.001 compared to no treatment, and was lower for users of tobacco (RR 1.39, P=0.032), and those with poor risk cytogenetics (RR: 3.96, P=0.002) or poor performance status (RR: 1.69, P<0.001). Furthermore, an association between statin use at the time of diagnosis (OR: 2.89, P=0.016) and increased complete remission after intensive chemotherapy was identified, while prior solid organ transplantation was associated with significantly lower complete remission rate after therapy (OR: 0.10, P=0.035). CONCLUSION: Our results provide evidence that specific epidemiologic exposures, including obesity, are significantly associated with unique AML cytogenetic risk categories and response to therapy. This supports a link between patient lifestyles, clinical exposures, and leukemogenesis.
Authors: María Facenda-Lorenzo; Ana Sánchez-Quintana; Alejandro Quijada-Fumero; Ana Laynez-Carnicero; Joaquín Breña-Atienza; Francisco J Poncela-Mireles; Juan M Llanos-Gómez; Ana I Cabello-Rodríguez; María Ramos-López Journal: Case Rep Oncol Med Date: 2016-08-23
Authors: Daniel Kristensen; Lars B Nielsen; Anne S Roug; Tove-Christina C Kristensen; Tarec C El-Galaly; Jan M Nørgaard; Claus W Marcher; Claudia Schöllkopf; Kim Theilgaard-Mönch; Marianne T Severinsen Journal: Br J Haematol Date: 2020-04-21 Impact factor: 6.998
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