Association between glycemic control, age, and outcomes among intensively treated patients with acute myeloid leukemia (AML).

Abstract

10043 Background: Hyperglycemia and increased glycemic variability are associated with infection and increased mortality. We evaluated the relationship between glycemic control during AML induction and outcomes by age. Methods: We retrospectively evaluated outcomes in 262 consecutive patients (pts) with newly diagnosed AML hospitalized for intensive induction at Wake Forest Baptist Hospital (2002-2009). Data on mean blood glucose (BG) (mg/dL) during hospitalization and standard deviation (SD) of BG (measure of glycemic variability, GV), complete remission ± incomplete count recovery (CR+CRi), and overall survival (OS) were collected. Modified Charlson Comorbidity Index (CCI), diabetes, age, gender, race, cytogenetics, hemoglobin, WBC, LDH, body mass index, and insurance were used in uni- and multi-variate models. We used logistic regression to evaluate CR+CRi, and Cox proportional hazard models for OS, stratified by age ( < 60 vs ≥60 yrs). Results: 124 pts were < 60 (median age 47, median OS 23.1 months), 138 were ≥60 yrs (median age 70, median OS 7.9 months). Older pts had higher baseline comorbidity (CCI > 1 60.1% vs 25.8%) and a higher prevalence of diabetes (20.3% vs 7.3%). The mean ±SD number of BG values obtained per patient during hospitalization was 61±71. The mean ±SD of each individual’s mean BG during hospitalization was 111.6±16.4 in younger versus 121.7±25.9 older pts. The mean SD of BG values [GV] was 26.8±18.6 in younger versus 33±22.8 in older pts. In multivariable analysis higher mean BG was associated with lower odds of CR+CRi in younger (odds ratio (OR) 0.67, 95% CI 0.48-0.93) and older pts (OR 0.78, 95% CI 0.65-0.93) per 10 mg/dL BG increase. Higher mean BG was associated with shorter OS in older adults (HR 1.12, 95% CI 1.04-1.21). Higher GV was associated with lower odds of CR+CRi in younger (OR 0.73, 95% CI 0.56-0.96) and older (OR 0.71, 95% CI 0.57-0.88), as well as shorter OS in older pts (HR 1.17, 95% CI 1.08-1.26) for each 10 mg/dL SD increase in GV. Conclusions: Hyperglycemia and GV during intensive induction are associated with lower CR+CRi rates (all ages) and shorter OS among older adults.Glycemic control during induction may be a modifiable factor to improve AML outcomes.