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Association between glycemic control, age, and outcomes among intensively treated patients with acute myeloid leukemia

  • Patrick Kuhlman
  • Scott Isom
  • Timothy S. Pardee
  • Cynthia Burns
  • Bernard Tawfik
  • Zanetta S. Lamar
  • Bayard L. Powell
  • Heidi D. KlepinEmail author
Original Article
  • 40 Downloads

Abstract

Purpose

To investigate the impact of hyperglycemia and glycemic variability during intensive acute myeloid leukemia therapy (AML) on outcomes by age.

Methods

Retrospective study of 262 consecutive patients with newly diagnosed AML hospitalized for intensive induction. Hyperglycemia was assessed by mean blood glucose (BG) (mg/dL) during hospitalization and glycemic variability was determined by the standard deviation (SD) of mean BG. Outcomes were complete remission ± incomplete count recovery (CR + CRi), and overall survival (OS). We used logistic regression to evaluate CR + CRi, and Cox proportional hazard models for OS, stratified by age (< 60 vs ≥ 60 years).

Results

Older patients (N = 138, median age 70) had higher baseline comorbidity (CCI > 1 60.1% vs 25.8%) and prevalence of diabetes (20.3% vs 7.3%) compared to younger (N = 124, median age 47). The mean ± SD number of BG values obtained per patient during hospitalization was 61 ± 71. The mean (± SD) glucose (mg/dL) during hospitalization was 121.7 (25.9) in older patients (≥ 60 years) versus 111.6 (16.4) in younger. In older patients, higher mean glucose and greater glycemic variability were associated with lower odds of remission (OR 0.80, 95% CI 0.69–0.93 and OR 0.73, 95% CI 0.61–0.88 respectively, per 10-unit increase) and higher mortality rates (HR 1.13, 95% CI 1.05–1.21 and HR 1.17, 95% CI 1.09–1.26, respectively, per 10-unit increase) in multivariate analyses.

Conclusions

Our observations that hyperglycemia and increased glycemic variability were associated with lower remission rates and increased mortality in older patients suggest glycemic control may be a potentially modifiable factor to improve AML outcomes.

Keywords

Acute myeloid leukemia Hyperglycemia Glycemic variability Diabetes Older 

Notes

Acknowledgments

We thank Karen Klein, MA ELS (Research Support Core Wake Forest School of Medicine Clinical Translational Science Institute), for her editorial contributions to the manuscript.

Funding information

Research reported in this publication was supported by the National Cancer Institute’s Cancer Center Support Grant award number P30CA012197 issued to the Wake Forest Baptist Comprehensive Cancer Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute. Heidi. D. Klepin was supported by a Paul Beeson Career Development Award in Aging Research (K23AG038361; supported by NIA, AFAR, The John A. Hartford Foundation, and The Atlantic Philanthropies) and The Gabrielle’s Angel Foundation for Cancer Research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Wake Forest University School of MedicineWinston-SalemUSA
  2. 2.University of Texas Southwestern Medical CenterDallasUSA

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