Acute myeloid leukemia (AML) generally occurs in older patients, and the older the patient, the more likely he or she will have comorbidities, such as diabetes, that can impact treatment. At the American Society of Clinical Oncologists (ASCO) annual meeting in Chicago, researchers from Wake Forest University examined how glycemic control affects AML treatment outcomes.
Retrospectively, outcomes in 262 newly diagnosed AML patients were evaluated. Patients were grouped according to their age (under 60 or 60 and older) and hospitalized for intensive induction at Wake Forest Baptist Hospital (2002-2009) were evaluated, and treatment outcome [complete remission (CR), incomplete count recovery (CRi), overall survival] were tabulated in addition to patient data, including blood glucose levels, modified Charlson Comorbidity Index (CCI), diabetes, age, gender, race, cytogenetics, hemoglobin, WBC, LDH, body mass index, and insurance status. Uni- and multi-variate models were used to assess any correlations between survival and patient information.
Of the 262 patients, 124 were under 60 years of age (median age 47) with a median overall survival of 23.1 months and 138 were 60 years or older (median age 70) with a median overall survival of 7.9 months. Between the two age groups, the younger group had lower baseline comorbidity compared to the older group (CCI > 1 25.8% vs 60.1%) and a lower prevalence of diabetes (7.3% vs 20.3%).
Mean blood glucose levels during hospitalization was 111.6 ± 16.4 mg/dL in younger group versus 121.7 ± 25.9 mg/dL in the older group. Glucose variability, as measured by standard deviations of blood glucose, was 26.8±18.6 in the younger group vs 33±22.8 in the older group.
Multivariable analysis showed that higher blood glucose levels were associated with lower odds of CR+CRi in both the younger group (odds ratio (OR) 0.67, 95% CI 0.48-0.93) and the older group (OR 0.78, 95% CI 0.65-0.93) per 10 mg/dL blood glucose increase.
Higher blood glucose was also associated with shorter overall survival in the older group (HR 1.12, 95% CI 1.04-1.21). Multivariate analysis also showed that the greater the glucose variability, the lower odds of CR+CRi in younger (OR 0.73, 95% CI 0.56-0.96) and older (OR 0.71, 95% CI 0.57-0.88) patients.
The authors concluded that hyperglycemia and glucose variability can significantly impact treatment outcomes in patients with AML and efforts to lower glucose and glucose variability in these patients are warranted.
Kuhlman P, Isom S, Pardee TS, et al. Association between glycemic control, age, and outcomes among intensively treated patients with acute myeloid leukemia (AML). J Clin Oncol. 2017;35: (suppl; abstr 10043).