ASH 2023 | The effect of BMI on survival outcomes in adolescents and young adults with AML

So we know that patients that have increased obesity, i.e. increased body mass index, have poorer outcomes in the adolescent young adult population who have B-cell acute lymphoblastic leukemia. However, nobody’s really looked at the impact of BMI or weight on adolescent young adults who have acute myeloid leukemia. And that’s a unique entity because, unlike ALL patients, these patients don’t have steroids or asparaginase or drugs in their regimen that could be affecting their weight. So we took a look at a retrospective single institution study at 76 patients in the AYA category, between 18 and 39, and looked at their diagnoses of acute myeloid leukemia, their outcomes, event-free survival, percent going to transplant or relapsed, etc. And what we found, surprisingly, was that the actual outcomes of the acute myeloid leukemia therapy, i.e. remission rates, relapse and percentage of patients going to transplant were very similar. There was, interestingly more favorable risk patients by the ELN criteria in the obese, i.e. BMI greater than 30, as opposed to the underweight or normal weight people. But there was a stark difference in five year overall survival, and only 17% of patients in the obese category were still alive after five years, as opposed to two thirds of patients in the other BMI categories. Now, these data are intriguing and suggest that it’s not a transplant mortality or leukemia-related mortality, but actually maybe late-stage toxicities of therapy or other comorbidities that have led these very young people to have shorter outcomes after five years with this diagnosis. So further studies are underway to elucidate the causes of death, look at potential cardiotoxicity, as well as other weight-associated conditions, cardiovascular conditions, diabetes, etc., just highlighting the impact of obesity, even on our youngest adult patients with acute myeloid leukemia. 

I actually was asked that and saying maybe we should be giving semaglutide with chemotherapy to try to mitigate this, and that’s a really intriguing question. The other possibility I was asked at my poster session was whether these patients are generally genetically predisposed or genetically have higher incidences of cardiovascular mortality and that’s why at the time of their diagnosis, they were overweight. So regardless of whether they had acute leukemia, maybe their outcomes were going to be less because of that. So we don’t know. I mean, I think those are really intriguing questions, and hopefully we’ll have a follow up abstract in another amount of time.