Contributions
Abstract: EP461
Type: E-Poster Presentation
Session title: Acute myeloid leukemia - Clinical
Background
Acute myeloid leukemia (AML) is a heterogeneous hematologic neoplasm resulting from abnormal proliferation and differentiation of clonal myeloid precursor cells. Karyotype, genomic abnormalities and patient-related factors are known to play an important role in the prognostication of AML. However, little is known about the effects of serologic markers like N-terminal fragment of brain natriuretic peptide (pBNP) on the outcome of AML patients.
Aims
The aim of the present study was to evaluate the role of pBNP as prognostic marker in patients with AML.
Methods
We analyzed 312 AML patients (median age: 61 years; range 17-89 years; f:m-ratio: 1:1.15) treated between February 1998 and September 2020 with 3+7-based induction chemotherapy and consolidation with up to 4 cycles of intermediate-dose or high-dose ARA-C.
Results
In 199 patients (63.8%), elevated pBNP levels were detected, and in 113 patients (36.2%), pBNP levels were within normal range (0-125 pg/ml). In 20 patients (6.4%), pBNP exceeded 2000 pg/mL. We found a weak correlation between age and pBNP (R=0.18) and a significant difference in pBNP levels when comparing high-risk (226.5 pg/mL), intermediate-risk (156.0 pg/mL) and low-risk patients (139.3 pg/mL) by Charlson comorbidity index (CCI) (p=0.002). No significant difference in pBNP levels was observed between male (median pBNP 193.5 pg/mL; range: 1-19833) and female (median pBNP 192 pg/mL; range: 1-15930) patients (p=0.33) or when comparing the body mass index (BMI) with pBNP levels (p=0.94). Following induction therapy, 219 patients (70.2%) achieved a complete remission (CR), 63 (20.2%) had no remission (NR), and 30 (9.6%) died from early death (ED). Median pBNP levels differed significantly among CR, NR and ED patients, with 153.3, 225.9, and 735.5 pg/mL, respectively (p=0.001). In multivariate analyses including age, sex, the ELN-2009 classification, BMI, CCI and pBPN, only pBNP and the ELN-2009 classification were independent predictors for response to induction therapy (p=0.007 and p<0.0001, respectively). Overall survival (OS) differed significantly between patients with normal, moderately elevated (125-2000 pg/mL) and highly elevated pBNP (>2000 pg/mL) (p<0.001). This difference was also observed when analyzing OS in patients <60 years (p=0.012), but was not seen in patients aged ≥60 years. Inmultivariate analysis (including age, the ELN-2009 classification, white blood counts, sex, CCI and pBNP) age, the ELN-2009 classification and pBNP remained independent predictive variables for OS (p=0.002, p<0.0001, and p=0.035, respectively). There was no significant difference in pBNP levels at diagnosis between patients who died from progressive disease, bleedings, infections, multi organ failure, pulmonary deterioration, cardiac problems or other reasons during the observation period (p=0.26). With regard to continuous complete remission pBNP was of prognostic significance in the cohort aged <60 years (p=0.011) but not in patients aged ≥60 years.
Conclusion
Together, pBNP is an independent prognostic factor and new biomarker indicating the risk of induction failure, early death and reduced OS in AML. Our data also show that the predictive power of pBNP as independent risk factor is most evident and most useful in patients <60 years.
Keyword(s):
Abstract: EP461
Type: E-Poster Presentation
Session title: Acute myeloid leukemia - Clinical
Background
Acute myeloid leukemia (AML) is a heterogeneous hematologic neoplasm resulting from abnormal proliferation and differentiation of clonal myeloid precursor cells. Karyotype, genomic abnormalities and patient-related factors are known to play an important role in the prognostication of AML. However, little is known about the effects of serologic markers like N-terminal fragment of brain natriuretic peptide (pBNP) on the outcome of AML patients.
Aims
The aim of the present study was to evaluate the role of pBNP as prognostic marker in patients with AML.
Methods
We analyzed 312 AML patients (median age: 61 years; range 17-89 years; f:m-ratio: 1:1.15) treated between February 1998 and September 2020 with 3+7-based induction chemotherapy and consolidation with up to 4 cycles of intermediate-dose or high-dose ARA-C.
Results
In 199 patients (63.8%), elevated pBNP levels were detected, and in 113 patients (36.2%), pBNP levels were within normal range (0-125 pg/ml). In 20 patients (6.4%), pBNP exceeded 2000 pg/mL. We found a weak correlation between age and pBNP (R=0.18) and a significant difference in pBNP levels when comparing high-risk (226.5 pg/mL), intermediate-risk (156.0 pg/mL) and low-risk patients (139.3 pg/mL) by Charlson comorbidity index (CCI) (p=0.002). No significant difference in pBNP levels was observed between male (median pBNP 193.5 pg/mL; range: 1-19833) and female (median pBNP 192 pg/mL; range: 1-15930) patients (p=0.33) or when comparing the body mass index (BMI) with pBNP levels (p=0.94). Following induction therapy, 219 patients (70.2%) achieved a complete remission (CR), 63 (20.2%) had no remission (NR), and 30 (9.6%) died from early death (ED). Median pBNP levels differed significantly among CR, NR and ED patients, with 153.3, 225.9, and 735.5 pg/mL, respectively (p=0.001). In multivariate analyses including age, sex, the ELN-2009 classification, BMI, CCI and pBPN, only pBNP and the ELN-2009 classification were independent predictors for response to induction therapy (p=0.007 and p<0.0001, respectively). Overall survival (OS) differed significantly between patients with normal, moderately elevated (125-2000 pg/mL) and highly elevated pBNP (>2000 pg/mL) (p<0.001). This difference was also observed when analyzing OS in patients <60 years (p=0.012), but was not seen in patients aged ≥60 years. Inmultivariate analysis (including age, the ELN-2009 classification, white blood counts, sex, CCI and pBNP) age, the ELN-2009 classification and pBNP remained independent predictive variables for OS (p=0.002, p<0.0001, and p=0.035, respectively). There was no significant difference in pBNP levels at diagnosis between patients who died from progressive disease, bleedings, infections, multi organ failure, pulmonary deterioration, cardiac problems or other reasons during the observation period (p=0.26). With regard to continuous complete remission pBNP was of prognostic significance in the cohort aged <60 years (p=0.011) but not in patients aged ≥60 years.
Conclusion
Together, pBNP is an independent prognostic factor and new biomarker indicating the risk of induction failure, early death and reduced OS in AML. Our data also show that the predictive power of pBNP as independent risk factor is most evident and most useful in patients <60 years.
Keyword(s):