Smoking adversely affects survival in acute myeloid leukemia patients

Abstract

Smoking adversely affects hematopoietic stem cell transplantation outcome. We asked whether smoking affected outcome of newly diagnosed acute myeloid leukemia (AML) patients treated with chemotherapy. Data were collected on 280 AML patients treated with high-dose cytarabine and idarubicin-containing regimens at Roswell Park Cancer Institute who had smoking status data at diagnosis. Patients' gender, age, AML presentation (de novo vs. secondary), white blood cell (WBC) count at diagnosis, karyotype and smoking status (never vs. ever) were analyzed. Among the 161 males and 119 females with a median follow-up of 12.9 months, 101 (36.1%) had never smoked and 179 (63.9%) were ever smokers. The proportion of patients between never and ever smokers was similar to respect to age, AML presentation, WBC count at diagnosis or karyotype based on univariate analysis of these categorical variables. Never smokers had a significantly longer overall survival (OS) (60.32 months) compared to ever smokers (30.89; p = 0.005). In multivariate analysis incorporating gender, age, AML presentation, WBC count, karyotype and smoking status as covariates, age, karyotype and smoking status retained prognostic value for OS. In summary, cigarette smoking has a deleterious effect on OS in AML.

Overall and progression free survival of similarly-treated AML patients by smoking status. 1A: Overall Survival of 244 similarly-treated AML patients (188 events, 56 censored) by smoking status based obtained from Cox proportional hazard model. Cox proportional hazard model assessing overall survival was adjusted for gender, age, AML presentation (de novo vs. secondary), WBC count at diagnosis, and karyotypes (unfavorable, intermediate, favorable). Model and survival plot were stratified by patient smoking status. 1B: Progression-free survival of 164 patients (118 events, 46 censored) by smoking status obtained from Cox proportional hazard model. Cox proportional hazard model assessing progression-free survival was adjusted for gender, age, AML presentation (de novo vs. secondary), WBC count at diagnosis, and karyotypes (unfavorable, intermediate, favorable). Model and survival plot were stratified by patient smoking status.