Nutritional and prognostic value of bioelectrical phase angle as a potentially modifiable marker in acute myeloid leukemia

Abstract

Phase angle (PhA), as measured by bioelectrical impedance analysis, is an important parameter in nutritional assessment and is highly predictive of clinical outcomes in various diseases; however, there is little research on its use in acute myeloid leukemia (AML). Therefore, the present study was conducted to determine the association between PhA and malnutrition and to clarify the prognostic significance of PhA for progression-free survival (PFS) and overall survival (OS) in adult patients with AML (excluding acute promyelocytic leukemia) who were undergoing chemotherapy. A total of 70 patients with newly diagnosed AML were enrolled. After chemotherapy, the nutritional risk for patients with a reduced baseline PhA increased significantly. Disease progression occurred in 28 patients, of which 23 died, with a median follow-up of 9.3 months. A reduced baseline PhA was associated with poor PFS (7.1 months vs. 11.6 months; P=0.001) and OS (8.2 months vs. 12.1 months; P=0.011). A multivariate analysis revealed that a reduced PhA was an independent risk factor for disease progression (hazard ratio, 3.13; 95% CI, 1.21-8.11; P=0.019). Overall, these results suggested that PhA is an effective and sensitive indicator that may provide important nutritional and prognostic information in patients with AML.

Keywords: acute myeloid leukemia; bioelectrical impedance analysis; chemotherapy; nutrition; phase angle; survival.

Figure 1

Flow chart of the study design and patient selection criteria. AML, acute myeloid leukemia; APL, acute promyelocytic leukemia; BIA, bioelectrical impedance analysis; HSCT, hematopoietic stem-cell transplantation.

Figure 2

Kaplan-Meier curves for (A) PFS and (B) OS. PFS, progression-free survival; OS, overall survival; PhA, phase angle; HR, hazard ratio; CI, confidence interval.