Influence of body mass index on incidence and prognosis of acute myeloid leukemia and acute promyelocytic leukemia: A meta-analysis

Abstract

Previous studies have demonstrated an association between high body mass index (BMI) and acute myeloid leukemias (AML), particularly acute promyelocytic leukemia (APL). However, the effect of obesity and overweight on the incidence of AML is not supported by all studies, and the relationship between obesity and prognosis of AML and APL has not been established. Thus, we conducted a meta-analysis to determine the role of BMI on the risk and clinical outcome of AML, including APL. Twenty-six eligible studies enrolling 12,971 AML (including 866 APL) patients were retrieved and analyzed. Overweight and obesity was associated with an increased incidence of AML (relative risk [RR], 1.23; 95% confidence interval [CI], 1.12–1.35; P < 0.001). High BMI did not significantly affect overall survival (OS) (hazard ratio [HR], 0.97; 95% CI, 0.92–1.03; P = 0.323) or disease-free survival (HR, 0.98; 95% CI, 0.88–1.10; P = 0.755) in patients with non-APL AML. By contrast, APL patients with high BMI had shorter OS (HR, 1.77; 95% CI, 1.26–2.48; P = 0.001) and a higher risk of differentiation syndrome (HR, 1.53; 95% CI, 1.03–2.27, P = 0.04). Overall, our findings suggest that patients with overweight or obesity have a higher incidence of AML, and high BMI is a predictor of adverse clinical outcomes in APL.

Characteristics and outcome of adult patients with acute promyelocytic leukemia and increased body mass index treated with the PETHEMA Protocols

“…Regarding the clinical outcomes, we found that, in line with the previous study by Breccia et al, Li et al, and Castillo et al, overweight/obese APL patients had lower OS . However, we were not able to reproduce the higher relapse risk reported in the Italian study of adult APL patients homogeneously treated with ATRA and chemotherapy (5‐year CIR 32% in APL with BMI ≥25% vs 11%).…”

“…To our knowledge, this is the largest study analysing the prognostic impact of overweight/obesity, as we studied 1320 APL patients, as compared with previous studies, Castillo et al (n = 446), Breccia et al (n = 144), Estey et al (n = 120 patients), and by Jeddi et al (n = 39). In addition, Li et al, performed a metanalysis including 866 APL patients.…”

“…Several studies have suggested worse clinical outcome in obese/overweight patients with APL. In particular, obesity/overweight has been related to shorter overall survival (OS), higher incidence of differentiation syndrome (DS) and an increased cumulative incidence of relapse (CIR) after front‐line therapy with ATRA and chemotherapy‐based protocols.…”

“…[3][4][5][6] It was previously reported that the percentage of obese patients with acute promyelocytic leukemia (APL) is higher than that observed in patients with non-APL AML. 5,6 Several studies [6][7][8][9] have suggested worse clinical outcome in obese/overweight patients with APL. In particular, obesity/overweight has been related to shorter overall survival (OS), higher incidence of differentiation syndrome (DS) and an increased cumulative incidence of relapse (CIR) after front-line therapy with ATRA and chemotherapy-based protocols.…”

Geographic Hematology: Some Observations in Mexico

“…The geographic variation suggests a possible genetic predisposition or environmental exposures to specific risk factors. Other factors such as obesity and dietary patterns have been linked to APL [36,37]. An increased BMI has been independently associated with a higher incidence of APL in Latino patients living in the USA [37].…”