Laura Finn
Mayo Clinic, USA
Title: Epidemiology of adult acute myeloid leukemia: Impact of exposures on clinical phenotypes and outcomes after therapy
Biography
Biography: Laura Finn
Abstract
An increased risk of adult myeloid leukemia (AML) is associated with lifestyle and environmental exposures, including obesity, smoking, medications, and rural/farm habitats in case control studies. The association of exposures with AML cytogenetics, therapeutic outcomes, and survival is unknown. Relevant exposures were evaluated in 295 AML patients diagnosed and treated at Mayo Clinic. Our central cytogenetic laboratory reviewed standard cytogenetic categories. The association of exposures with cytogenetic risk, complete remission (CR) after therapy, and overall survival was evaluated using logistic and Cox regression models. A significant association between obesity and intermediate-abnormal cytogenetics was identified (OR: 1.94, P = 0.025). Secondary AML pateints 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 smokers (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). Association between statins (OR: 2.89, P = 0.016) and increased CR after intensive chemotherapy was identified. Solid organ transplantation was associated with lower CR after therapy (OR: 0.10, P = 0.035). Our results provide evidence that specific epidemiologic exposures are significantly associated with AML cytogenetic risk categories and response to therapy. This supports a link between patient lifestyles, clinical exposures, and leukemogenesis.