Simple acute phase protein score to predict long‐term survival in patients with acute myeloid leukemia

Heini, Alexander D; Hugo, Rebecca; Berger, Martin D.; Novak, Urban; Bacher, Ulrike; Pabst, Thomas

doi:10.1002/hon.2696

Cited by 12 publications

(8 citation statements)

References 45 publications

(47 reference statements)

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“… 17 Similarly, the Glasgow prognostic score (GPS) and modified GPS (mGPS), determined by the serum CRP and albumin levels, have been proposed as prognostic indicators for AML patients. 18 However, the clinical correlations of CAR and its prognostic value in AML patients have not yet been clarified. Therefore, we retrospectively investigated whether CAR has prognostic potential in patients with newly diagnosed non-M3 AML.…”

Section: Introductionmentioning

confidence: 99%

The Prognostic Significance of C-Reactive Protein to Albumin Ratio in Newly Diagnosed Acute Myeloid Leukaemia Patients

Li¹,

Shi²,

Song³

et al. 2022

CMAR

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Background The ratio of C-reactive protein to albumin (CAR) is an inflammatory marker that has been demonstrated to be a simple and reliable prognostic factor in several solid tumours and chronic lymphocytic leukaemia (CLL). However, no studies have investigated the prognostic value of the CAR in patients with acute myeloid leukaemia (AML). Objectives and Methods We retrospectively analysed 212 newly diagnosed non-M3 AML patients. Using the receiver operating characteristic curve (ROC) method, the optimal cut-off value for CAR was determined. We investigated the correlations of the pretreatment CAR levels with clinical characteristics, treatment response of induction chemotherapy, overall survival (OS) and event-free survival (EFS). We also assessed the prognostic value of the CAR compared with other inflammation-based prognostic parameters by the area under the curve (AUC). Results According to the ROC curve, the optimal cut-off value of CAR was 1.015. CAR was associated with age, C-reactive protein (CRP) levels, albumin levels, ferritin levels, bone marrow blast percentage, French-American-British (FAB) classification, immunophenotype and 2017 European Leukemia Net (2017 ELN) risk stratification. Importantly, we found that high CAR was a powerful indicator of a lower complete remission (CR) rate ( p <0.001), worse OS ( p <0.001) and worse EFS ( p <0.001). Subgroup analysis showed that a high CAR was associated with shorter OS and EFS in patients with intermediate risk stratification or those aged ≤65 years or those without haematopoietic stem cell transplantation (HSCT). In the multivariate analysis, the CAR was an independent prognostic factor for OS and EFS. Furthermore, the predictive value of CAR for OS is superior to that of CRP, albumin and GPS in de novo AML patients aged ≤65 years old. Conclusion CAR is a simple and effective prognostic marker in patients with AML. It could be an additional prognostic factor that help further precise the current risk stratification of non-M3 AML, particularly for patients in intermediate risk stratification and those aged ≤65 years and those who did not undergo HSCT.

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Section: Introductionmentioning

confidence: 99%

The Prognostic Significance of C-Reactive Protein to Albumin Ratio in Newly Diagnosed Acute Myeloid Leukaemia Patients

Li¹,

Shi²,

Song³

et al. 2022

CMAR

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“…AML, like many other malignancies, is an inflammatory disease and there are ongoing attempts to incorporate acute phase proteins such as albumin into predictive models 22,[27][28][29]. Heini et al, conducted a retrospective evaluation of the prognostic value of Creactive protein, fibrinogen and albumin (CFA) levels in a ratio and found that patients with a lower CFA ratio had longer progression free survival, disease free survival and OS (61.2 vs. 13.8 months, p < 0.01) after intensive treatment relative to those with a higher CFA ratio 29. Similarly, a novel predictive model for OS was created by Silveria et al in newly diagnosed AML combining an adaptive genetic risk score and clinical prognostic parameters including hypoalbuminemia (defined as <3.8 g/dl) 30.…”

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confidence: 99%

Hypoalbuminemia as a prognostic biomarker for higher mortality and treatment complications in acute myeloid leukemia

Doucette

Percival

Williams

et al. 2021

Hematological Oncology

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Older age and poor performance status lead to worse outcomes in acute myeloid leukemia (AML) patients. Hypoalbuminemia is a negative predictor of morbidity and mortality in several malignancies. We evaluated the relationship between baseline serum albumin levels on treatment‐related complications, as well as short‐term mortality and overall survival (OS) in 756 newly diagnosed AML patients. We conducted a retrospective multicenter study to examine treatment‐related complications and OS according to pretreatment serum albumin levels: normal albumin ≥3.5 g/dl, marked hypoalbuminemia <2.5 g/dl, and hypoalbuminemia 2.5–3.4 g/dl. In an adjusted multivariate analysis, a lower baseline albumin was independently associated with a higher number of grade ≥3 complications when adjusting for age, secondary AML, sex and intensive treatment. When comparing normal to markedly low albumin levels, the estimated mean number of complications increases by a factor of 1.35. Patients who had a normal baseline albumin had a 30 day‐mortality rate of 4.8%, which was significantly lower compared with patients with hypoalbuminemia (16.5%) and marked hypoalbuminemia (33.9%; p < 0.01). Similarly, 60‐day mortality rate was significantly higher in the hypoalbuminemia group (24.0%) and marked hypoalbuminemia group (45%) compared with normal albumin group (8.3%; p < 0.01). Patients with lower baseline albumin levels have increased treatment‐related morbidity and mortality, suggesting that pre‐treatment serum albumin is an important independent prognostic marker.

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“…It is assumed that 75%-85% (9-14 μmol/L) of Zn in the body is bound to albumin, which is the major part of the Zn exchange pool. In this study, SCZR was closely related to ALB and CRP levels, which were reported to be associated with adverse outcomes in patients with newly diagnosed AML undergoing intensive induction [40,41]. Previous studies revealed the validity of the SCZR for the severity of nutritional status, inflammation, oxidative stress, immune dysfunction, and infection associated with Zn deficiency [42].…”

Section: Discussionmentioning

confidence: 62%

The trace that is valuable: serum copper and copper to zinc ratio for survival prediction in younger patients with newly diagnosed acute myeloid leukaemia

Shi

Wei

et al. 2023

BMC Cancer

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Purpose No data on predicting the survival of AML patients based on the level of trace elements in the serum have been presented to date. The aims of this prospective cohort study were as follows: (i) to evaluate the serum Cu and Zn levels in people from Northeast China, (ii) to assess the association between the serum Cu level (SCL) and Cu to Zn ratio (SCZR) and clinical and nutrition data, and (iii) to investigate the predictive values of the SCL and SCZR in newly diagnosed de novo AML patients. Methods A total of 105 newly diagnosed AML patients and 82 healthy controls were recruited. The serum Cu and Zn levels were determined by inductively coupled plasma spectrometry. The associations of SCL and SCZR with the survival of these AML patients were assessed by Cox proportional hazards models. Results Both SCL and SCZR were positively related to the blast percentage of bone marrow and C-reactive protein, negatively related to albumin level and CEBPA double mutation and were significantly associated with worse overall survival and disease-free survival. Meanwhile, patients with higher SCL had worse CTCAE levels, and patients with higher SCZR showed less complete remission during the first course of induction chemotherapy. Moreover, higher SCZR was positively associated with ELN risk stratification, and was negatively associated with haemoglobin level and prognostic nutritional index (PNI). Conclusion The SCL and SCZR are associated with long-term survival in patients with newly diagnosed AML undergoing intensive induction and may serve as important predictive biomarkers.

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Simple acute phase protein score to predict long‐term survival in patients with acute myeloid leukemia

Cited by 12 publications

References 45 publications

The Prognostic Significance of C-Reactive Protein to Albumin Ratio in Newly Diagnosed Acute Myeloid Leukaemia Patients

The Prognostic Significance of C-Reactive Protein to Albumin Ratio in Newly Diagnosed Acute Myeloid Leukaemia Patients

Hypoalbuminemia as a prognostic biomarker for higher mortality and treatment complications in acute myeloid leukemia

The trace that is valuable: serum copper and copper to zinc ratio for survival prediction in younger patients with newly diagnosed acute myeloid leukaemia

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