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Observational Study
. 2020 Apr;11(3):410-416.
doi: 10.1016/j.jgo.2019.03.014. Epub 2019 Apr 5.

Inflammatory biomarkers, geriatric assessment, and treatment outcomes in acute myeloid leukemia

Kah Poh Loh  1 , Janet A Tooze  2 , Barbara J Nicklas  3 , Stephen B Kritchevsky  3 , Jeff D Williamson  3 , Leslie R Ellis  4 , Bayard L Powell  4 , Timothy S Pardee  4 , Neha G Goyal  5 , Heidi D Klepin  4
Affiliations
Observational Study

Inflammatory biomarkers, geriatric assessment, and treatment outcomes in acute myeloid leukemia

Kah Poh Loh et al. J Geriatr Oncol. 2020 Apr.

Abstract

Objectives: To investigate changes in inflammatory biomarkers during induction therapy for older adults with acute myeloid leukemia (AML) and their associations with geriatric assessment (GA) measures and outcomes.

Methods: This was a single institution ancillary study to a prospective observational study (N = 20 consecutive adults aged ≥60 with newly diagnosed AML who received induction chemotherapy). Biomarkers (Interleukin-6 [IL-6], IL-6 soluble receptor [IL-6 sR], tumor necrosis factor alpha [TNFα], TNFα soluble receptor 1 [TNFα sR1], interleukin-3 [IL-3], C-reactive protein [CRP]) were collected at start of induction, weekly for three weeks, and post-induction and were compared over time using paired t-tests. GA was administered at baseline and post-induction, and correlated with biomarker levels using Spearman correlations. Survival was estimated using Kaplan-Meier and compared by categorized biomarker level using Wilcoxon tests.

Results: Biomarker levels were stable during induction, except for CRP and IL-6 sR. Declines in objectively measured physical function [Short Physical Performance Battery (SPPB); r = 0.71, p < 0.01] and increases in self-reported limitation in instrumental activities of daily living (r = 0.81, p < 0.01) were correlated with increased TNFα sR1. Declines in SPPB were correlated with increased CRP (r = -0.73, p < 0.01). Improvement in depression was correlated with increased IL-6 sR (r = -0.59 p = 0.02). Survival was shorter in those with baseline TNFα or CRP levels above the median (6.1 vs. 40.2 months and 5.5 vs. 27.6 months respectively, p = 0.04 for both).

Conclusion: Among older adults with AML, the relationships between TNFα sR1, CRP, and IL-6 sR with change in physical and emotional health during treatment warrants further investigation.

Keywords: Acute myeloid leukemia; Biomarkers; Geriatric assessment; Inflammation; Older adults.

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Conflict of interest statement

The authors have no relevant conflicts of interest to report.

Figures

Figure 1:
Figure 1:. Mean levels of inflammatory biomarkers over time
Baseline represents week 0, then weekly hospital measures, and post-hospitalization post-remission follow-up (approximately week 7). *There was significant overall week effect for CRP (p<0.01). CRP levels increased from baseline to week 1, and decreased from week 3 to follow-up (week 1–3 to follow-up; p<0.01). #There was significant overall week effect for CRP (p<0.01). IL-6 sR levels decreased from baseline to week 1, then increased from week 3 to follow-up (week 1–3 to follow-up; p<0.01).
Figure 2.
Figure 2.. Association of baseline level of TNFα and CRP with survival among older adults receiving induction therapy for AML
See this image and copyright information in PMC

References

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