AML-382 Cardiovascular Disease and Diabetes Mellitus Impact Outcomes of Patients With Acute Myeloid Leukemia

Abstract

Incidence of both cardiovascular disease (CVD) and acute myeloid leukemia (AML) increases with age, and patients with AML more frequently have preexisting diabetes mellitus (DM), congestive heart failure, and myocardial infarction than non-cancer patients. We examined the influence of preexisting CVD and cardiovascular risk factors on the clinical outcomes of patients with AML. A total of 291 adult patients with AML with available smoking history treated at the University of Maryland Greenebaum Comprehensive Cancer Center 2014-2020 were reviewed retrospectively. Comorbidities identified through chart review were analyzed individually. Fisher's exact and t-tests were used to compare on-study characteristics and the outcomes of patients with and without CVD. Response rate (CR, CRi), overall survival (OS), and cumulative incidence of relapse were evaluated. OS was estimated by the Kaplan-Meier method. The multivariable logistic regression model was used to estimate the probability of achieving the best response. One-third of patients (34%) had preexisting CVD at AML diagnosis. Patients with CVD were more likely to have worse performance status and secondary AML (both P=0.03) and receive hypomethylating agent (HMA)-based induction therapy (72% vs. 38%, P<0.001). With a median follow-up of 40 months, CVD was associated with a lower probability of achieving CR or CRi (0.45 vs. 0.71, P<0.001). Having DM was independently associated with a worse response to treatment accounting for other on-study characteristics (OR=0.24, 95% CI: 0.08-0.80, P=0.01). Accounting for age, performance status, presence of complex karyotype, or secondary disease and treatment, CVD patients had worse OS than non-CVD patients (HR=1.5, 95% CI: 1.1-2.2, P=0.002), with 1- and 3-year OS of 44% versus 67% and 25% versus 40%, respectively (HR=1.9, 95% CI: 1.4-3.5, P<0.001), but no difference in cumulative incidence of relapse. Smoking did not impact OS (P=0.7). Sixty-two patients (21%) received allogeneic stem cell transplants, including 27% with preexisting CVD, and these patients had a worse OS (HR=2, 95% CI: 1-3.9). AML patients with CVD and those with DM have worse treatment outcomes and survival. Further clinical studies are required to understand the impact of CVD on the outcomes of AML patients.