Abstract
Previous studies have demonstrated an association between high body mass index (BMI) and acute myeloid leukemias (AML), particularly acute promyelocytic leukemia (APL). However, the effect of obesity and overweight on the incidence of AML is not supported by all studies, and the relationship between obesity and prognosis of AML and APL has not been established. Thus, we conducted a meta-analysis to determine the role of BMI on the risk and clinical outcome of AML, including APL. Twenty-six eligible studies enrolling 12,971 AML (including 866 APL) patients were retrieved and analyzed. Overweight and obesity was associated with an increased incidence of AML (relative risk [RR], 1.23; 95% confidence interval [CI], 1.12–1.35; P < 0.001). High BMI did not significantly affect overall survival (OS) (hazard ratio [HR], 0.97; 95% CI, 0.92–1.03; P = 0.323) or disease-free survival (HR, 0.98; 95% CI, 0.88–1.10; P = 0.755) in patients with non-APL AML. By contrast, APL patients with high BMI had shorter OS (HR, 1.77; 95% CI, 1.26–2.48; P = 0.001) and a higher risk of differentiation syndrome (HR, 1.53; 95% CI, 1.03–2.27, P = 0.04). Overall, our findings suggest that patients with overweight or obesity have a higher incidence of AML, and high BMI is a predictor of adverse clinical outcomes in APL.
Highlights
The prevalence of obesity has been increasing worldwide over the past decades
A total of 7,475 studies were retrieved from the preliminary literature search (PubMed:[2,362], EMBASE:[2,302], Web of Science:[2,636], and the Cochrane library:175), and an additional two studies were identified from a review of citations. 173 potential relevant publications were retrieved for detailed evaluation
The pooled relative risk (RR) indicated that high body mass index (BMI) was associated with increased risk for Acute myeloid leukemia (AML) (RR, 1.23; 95% confidence interval (CI), 1.12–1.35; P < 0.001; I2 = 66.0%; random effects; Fig. 2A)
Summary
The prevalence of obesity has been increasing worldwide over the past decades. According to World Health Organization (WHO), overweight and obesity are defined by a body mass index (BMI) of 25–29.9 kg/m2 and ≥30 kg/m2, respectively. The most recent meta-analysis on this topic was performed in 2012 and suggested that obesity, but not overweight, increases incidence of AML7. The number of patients with AML was limited because this meta-analysis included all types of leukemia and only included five studies on AML. Including two large multinational survey programs, have been published[5,6,10,12,13] Including these new studies in an updated analysis is needed to comprehensively evaluate the association between BMI and risk for AML. In addition to the incidence of AML, the association between high BMI and the prognosis of AML is unclear due to the lack of a meta-analysis, several studies have investigated this issue[14,15,16]. To our knowledge, a quantitative analysis that evaluates this association with APL is not available
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